Provider Demographics
NPI:1366959611
Name:GOLDEN ARC HOMECARE SOLUTION INC.
Entity type:Organization
Organization Name:GOLDEN ARC HOMECARE SOLUTION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DANILLIE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-525-0696
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:GONZALEZ
Mailing Address - State:FL
Mailing Address - Zip Code:32560-0845
Mailing Address - Country:US
Mailing Address - Phone:850-525-0696
Mailing Address - Fax:
Practice Address - Street 1:196 E NINE MILE RD STE D
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-3119
Practice Address - Country:US
Practice Address - Phone:850-525-0696
Practice Address - Fax:850-525-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 385H00000X
FL299994727251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024258500Medicaid