Provider Demographics
NPI:1184486243
Name:GOLDEN VOW HOME LLC
Entity type:Organization
Organization Name:GOLDEN VOW HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-806-2875
Mailing Address - Street 1:5229 INADALE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1536
Mailing Address - Country:US
Mailing Address - Phone:323-806-2875
Mailing Address - Fax:
Practice Address - Street 1:414 W ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6541
Practice Address - Country:US
Practice Address - Phone:323-806-2875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health