1639429392 NPI number — GOLDEN TOUCH HOME HEALTH CARE, LLC

Table of content: LARISSA MIYACHI KIWAKYOU MD (NPI 1740784321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639429392 NPI number — GOLDEN TOUCH HOME HEALTH CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDEN TOUCH HOME HEALTH CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639429392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2888 E. LONG LAKE RD
Provider Second Line Business Mailing Address:
SUITE 125
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-602-3830
Provider Business Mailing Address Fax Number:
243-404-6836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2888 E. LONG LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-602-3830
Provider Business Practice Location Address Fax Number:
248-404-6836
Provider Enumeration Date:
09/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DELA CRUZ
Authorized Official First Name:
URSILA
Authorized Official Middle Name:
JAHARIA
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
586-819-8005

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  D8009U , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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