Healthcare Provider Details

I. General information

NPI: 1437687910
Provider Name (Legal Business Name): GOLDEN TIMES CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11036 N 28TH DR UNIT 111
PHOENIX AZ
85029-4305
US

IV. Provider business mailing address

11036 N 28TH DR UNIT 111
PHOENIX AZ
85029-4305
US

V. Phone/Fax

Practice location:
  • Phone: 480-399-0502
  • Fax:
Mailing address:
  • Phone: 480-399-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ABDUL RAHEEM ABDUL JABBAR
Title or Position: OWNER
Credential:
Phone: 480-399-0502