Healthcare Provider Details

I. General information

NPI: 1114284791
Provider Name (Legal Business Name): GOLDEN YEARS COMPANION CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 09/24/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S WABASH AVE SUITE 205
CHICAGO IL
60605-2547
US

IV. Provider business mailing address

1300 S WABASH AVE SUITE 205
CHICAGO IL
60605-2547
US

V. Phone/Fax

Practice location:
  • Phone: 312-447-0034
  • Fax: 312-447-0036
Mailing address:
  • Phone: 312-447-0034
  • Fax: 312-447-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3000650
License Number StateIL

VIII. Authorized Official

Name: MR. DANIEL L GRAY
Title or Position: PRESIDENT
Credential:
Phone: 312-447-0034