Healthcare Provider Details

I. General information

NPI: 1801227244
Provider Name (Legal Business Name): GOLDEN DAYS ELDERLY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N KANSAS AVE
LIBERAL KS
67901-3304
US

IV. Provider business mailing address

502 N KANSAS AVE PO BOX 1964
LIBERAL KS
67901-3304
US

V. Phone/Fax

Practice location:
  • Phone: 580-461-6127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA-088-007
License Number StateKS

VIII. Authorized Official

Name: JUANITA MONROE
Title or Position: OWNER
Credential:
Phone: 580-461-6127