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GOLDEN TRAINGLE LIVING CENTERS INC NPI 1134233059


NPI Information

NPI: 1134233059
Provider Name: GOLDEN TRAINGLE LIVING CENTERS INC

Doing Business As: JERRY LIVING CENTER

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization

CLIA Number: 45D2111703

Address:
4415 JERRY
BEAUMONT, TX
ZIP 77703
Phone: (409) 899-4766
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GOLDEN TRAINGLE LIVING CENTERS INC is an intermediate care facility mentally retarded in Beaumont, TX. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. GOLDEN TRAINGLE LIVING CENTERS INC NPI is 1134233059. The provider is registered as an organization entity type.
The provider Is Doing Business As Jerry Living Center.

The provider's business location address is:

4415 JERRY
BEAUMONT, TX
ZIP 77703
Phone: (409) 899-4766
Fax: (409) 832-8044

The provider's authorized official is Jerrine B Harrell .
The authorized official title is President and has the following contact phone number (318) 445-6470.

The CLIA number assigned to this NPI record is 45D2111703 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/18/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1315P00000XIntermediate Care Facility, Intellectual Disabilities115928TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
145G846MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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