MEDICARE: GOLDEN YEARS HOMECARE AGENCY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053875658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN YEARS HOMECARE AGENCY, LLC

Provider Business Mailing Address
First Line	:	2679 ARAMINGO AVE UNIT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-2331
Country	:	US
Telephone Number	:	267-239-2199
Fax Number	:	215-893-1778

Provider Business Practice Location Address
First Line	:	2679 ARAMINGO AVE UNIT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-2331
Country	:	US
Telephone Number	:	267-239-2199
Fax Number	:	215-893-1778

Authorized Official
Title or Position	:	MANAGER
Name	:	MITCHELL NIMAN
Credential	:
Telephone Number	:	267-239-2199

Provider Enumeration Date	:	01/28/2019
Last Update Date	:	01/28/2019

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