Provider Demographics
NPI:1871346775
Name:GOLDEN HARVEST CARE HOMES, LLC
Entity type:Organization
Organization Name:GOLDEN HARVEST CARE HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-733-9604
Mailing Address - Street 1:11623 CHANERA AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-1821
Mailing Address - Country:US
Mailing Address - Phone:131-073-3960
Mailing Address - Fax:323-880-8064
Practice Address - Street 1:11623 CHANERA AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-1821
Practice Address - Country:US
Practice Address - Phone:131-073-3960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility