Provider Demographics
NPI:1447094651
Name:GREAT GOLDEN CARE LLC
Entity type:Organization
Organization Name:GREAT GOLDEN CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:ERTHA
Authorized Official - Last Name:DORVILUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-394-9731
Mailing Address - Street 1:496 HIGHTREE PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-7134
Mailing Address - Country:US
Mailing Address - Phone:619-394-9731
Mailing Address - Fax:
Practice Address - Street 1:496 HIGHTREE PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-7134
Practice Address - Country:US
Practice Address - Phone:619-394-9731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)