Healthcare Provider Details

I. General information

NPI: 1639162837
Provider Name (Legal Business Name): GOLDEN YEARS ADULT DAYCARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 HAZEL ST
TEXARKANA AR
71854-5215
US

IV. Provider business mailing address

408 HAZEL ST
TEXARKANA AR
71854-5215
US

V. Phone/Fax

Practice location:
  • Phone: 870-772-1299
  • Fax: 870-772-3198
Mailing address:
  • Phone: 870-772-1299
  • Fax: 870-772-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number024
License Number StateAR

VIII. Authorized Official

Name: SARAH DENISE PEEK
Title or Position: OWNER/ ADMINISTRATOR
Credential:
Phone: 870-772-1299