Provider Demographics
NPI:1730801358
Name:5 GOLD STAR CARE
Entity type:Organization
Organization Name:5 GOLD STAR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:719-419-7977
Mailing Address - Street 1:2020 N ACADEMY BLVD STE 348
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1567
Mailing Address - Country:US
Mailing Address - Phone:719-419-7977
Mailing Address - Fax:719-419-7988
Practice Address - Street 1:211 E COSTILLA ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2103
Practice Address - Country:US
Practice Address - Phone:719-419-7977
Practice Address - Fax:719-419-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)