Basic Information
| Provider Information | |||||||||
| NPI: | 1598844391 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GOLDEN CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 W MEETING ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034168000 | ||||||||
| FaxNumber: | 8032830517 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 W MEETING ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034168000 | ||||||||
| FaxNumber: | 8032830517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BOWERS | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8034168000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | X | Agencies | Home Health | 261QA0600X | ADC233 | SC | X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
ID Information
| ID | Type | State | Issuer | Description | EX0675 | 05 | SC | MEDICAID |