Healthcare Provider Details

I. General information

NPI: 1811107782
Provider Name (Legal Business Name): GOLDEN YEARS SENIOR CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 E 1ST AVE
HUTCHINSON KS
67501-7112
US

IV. Provider business mailing address

414 E 1ST AVE
HUTCHINSON KS
67501-7112
US

V. Phone/Fax

Practice location:
  • Phone: 620-662-8519
  • Fax: 620-728-0150
Mailing address:
  • Phone: 620-662-8519
  • Fax: 620-728-0150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number078014
License Number StateKS

VIII. Authorized Official

Name: MS. LELA MARIE JENKS
Title or Position: OWNER- CO OWNER
Credential: OPERATOR
Phone: 620-662-8519