Healthcare Provider Details

I. General information

NPI: 1609932193
Provider Name (Legal Business Name): GOLDEN YEARS CARE HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7312 E JASMINE ST
MESA AZ
85207-2930
US

IV. Provider business mailing address

7312 E JASMINE ST
MESA AZ
85207-2930
US

V. Phone/Fax

Practice location:
  • Phone: 480-396-4490
  • Fax: 480-396-4490
Mailing address:
  • Phone: 480-396-4490
  • Fax: 480-396-4490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number789802
License Number StateAZ

VIII. Authorized Official

Name: MRS. EVELYN G STANSBARGER
Title or Position: OWNER
Credential:
Phone: 480-396-4490