Provider Demographics
NPI:1437987203
Name:GOLDEN TRAIL GROUP
Entity type:Organization
Organization Name:GOLDEN TRAIL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-300-8300
Mailing Address - Street 1:2793 SANTA FIORA DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-1113
Mailing Address - Country:US
Mailing Address - Phone:714-718-0625
Mailing Address - Fax:
Practice Address - Street 1:2793 SANTA FIORA DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-1113
Practice Address - Country:US
Practice Address - Phone:714-718-0625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)