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GOLD STAR ASSISTED LIVING
NPI 1396960993
Assisted Living Facility in Canton, TX

Active since April 17, 2007
503 W HIGHWAY 243, CANTON, TX 75103(903) 567-2762(903) 567-2237 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Table of Contents

  1. NPI Profile Information
  2. Primary Taxonomy
  3. Authorized Official
  4. Frequently Asked Questions
  • Organization
  • Assisted Living Facility

About GOLD STAR ASSISTED LIVING

This page provides the complete NPI Profile along with additional information for Gold Star Assisted Living, a provider established in Canton, Texas operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1396960993 assigned on April 2007. The practitioner's primary taxonomy code is 310400000X with license number 030299 (TX). The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Mr. Jerry Lynn Tidwell (Manager)

NPI
1396960993 Verify this NPI
Provider Name
GOLD STAR ASSISTED LIVING
Entity Type
Organization
Location Address
503 W HIGHWAY 243 CANTON, TX 75103
Location Phone
(903) 567-2762
Location Fax
(903) 567-2237
Mailing Address
PO BOX 1090 CANTON, TX 75103
Mailing Phone
(903) 567-2762
Mailing Fax
(309) 567-2237
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
04-17-2007
Last Update Date
08-22-2020
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Assisted Living Facility

Taxonomy Code
310400000X
Type
Nursing & Custodial Care Facilities
License No.
030299
License State
TX
Taxonomy Description
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

MR. JERRY LYNN TIDWELL

Authorized Official Title
MANAGER
Authorized Official Phone
(903) 567-2762

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Frequently Asked Questions

What is GOLD STAR ASSISTED LIVING's NPI number?

The NPI number assigned to this healthcare provider is 1396960993, enumerated as an "organization" on April 17, 2007.

Where is the provider located?

The provider is located at 503 W HIGHWAY 243 CANTON, TX 75103 and the phone number is (903) 567-2762.

What is the provider's specialty?

Assisted Living Facility with taxonomy code 310400000X.