Provider Demographics
NPI:1386996692
Name:GOLDEN YEARS SENIOR CARE, INC.
Entity type:Organization
Organization Name:GOLDEN YEARS SENIOR CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOGHIREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-807-8666
Mailing Address - Street 1:7440 S US HIGHWAY 1
Mailing Address - Street 2:MARLIN PROFESSIONAL CENTRE
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-1417
Mailing Address - Country:US
Mailing Address - Phone:772-807-8666
Mailing Address - Fax:772-807-8866
Practice Address - Street 1:7440 S US HIGHWAY 1
Practice Address - Street 2:MARLIN PROFESSIONAL CENTRE
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1417
Practice Address - Country:US
Practice Address - Phone:772-807-8666
Practice Address - Fax:772-807-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211265251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690988400Medicaid