Provider Demographics
NPI:1154726107
Name:GOLDEN YEARS ADULT HEALTH SERVICES
Entity type:Organization
Organization Name:GOLDEN YEARS ADULT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ONEIL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-573-8651
Mailing Address - Street 1:121 COLONIAL GLN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3305
Mailing Address - Country:US
Mailing Address - Phone:601-573-8651
Mailing Address - Fax:
Practice Address - Street 1:121 COLONIAL GLN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3305
Practice Address - Country:US
Practice Address - Phone:601-573-8651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-01
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS302R00000X, 310400000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility