Provider Demographics
NPI:1811107782
Name:GOLDEN YEARS SENIOR CARE HOME
Entity type:Organization
Organization Name:GOLDEN YEARS SENIOR CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- CO OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JENKS
Authorized Official - Suffix:
Authorized Official - Credentials:OPERATOR
Authorized Official - Phone:620-662-8519
Mailing Address - Street 1:414 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-7112
Mailing Address - Country:US
Mailing Address - Phone:620-662-8519
Mailing Address - Fax:620-728-0150
Practice Address - Street 1:414 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-7112
Practice Address - Country:US
Practice Address - Phone:620-662-8519
Practice Address - Fax:620-728-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS078014302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization