Organization
GOLDEN SERVICES PERSONAL CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTIE BLAKE (OWNER/ADMINISTRATOR)
(229) 671-9020
Entity
Organization
Contact information
Practice address
930 W MAGNOLIA ST, VALDOSTA, GA 31601-3775
(229) 671-9020
Mailing address
930 W MAGNOLIA ST, VALDOSTA, GA 31601-3775
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
092020021
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2124679828A
—
GA
Enumeration date
07/17/2015
Last updated
07/17/2015
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