Provider Demographics
NPI:1962194266
Name:GOLDEN YEARS HOME CAREAGENCY
Entity type:Organization
Organization Name:GOLDEN YEARS HOME CAREAGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-643-0620
Mailing Address - Street 1:2468 PINE KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-7123
Mailing Address - Country:US
Mailing Address - Phone:252-643-0620
Mailing Address - Fax:252-643-0622
Practice Address - Street 1:106 W GORDON ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-4816
Practice Address - Country:US
Practice Address - Phone:252-643-0620
Practice Address - Fax:252-643-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care