Healthcare Provider Details

I. General information

NPI: 1023791068
Provider Name (Legal Business Name): GOLDEN YEARS ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LENNA AVE
SEFFNER FL
33584-4721
US

IV. Provider business mailing address

201 LENNA AVE
SEFFNER FL
33584-4721
US

V. Phone/Fax

Practice location:
  • Phone: 813-608-2363
  • Fax:
Mailing address:
  • Phone: 813-608-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: JESSICA TEMPFER
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 813-608-2363