Provider Demographics
NPI:1104323070
Name:GOLDEN YEARS ADULT DAYCARE OF JACKSON LLC
Entity type:Organization
Organization Name:GOLDEN YEARS ADULT DAYCARE OF JACKSON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-267-0818
Mailing Address - Street 1:155 CARRIAGE DR SUITE A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-506-9068
Mailing Address - Fax:
Practice Address - Street 1:1118 WHITEHALL STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3730
Practice Address - Country:US
Practice Address - Phone:731-736-2440
Practice Address - Fax:731-736-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care