Healthcare Provider Details

I. General information

NPI: 1952066748
Provider Name (Legal Business Name): GOLDEN WAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CENTRAL ST
WALTHAM MA
02453-5465
US

IV. Provider business mailing address

30 EASTBROOK RD STE 304
DEDHAM MA
02026-2084
US

V. Phone/Fax

Practice location:
  • Phone: 617-513-2158
  • Fax:
Mailing address:
  • Phone: 617-513-2158
  • 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: WOLF GAFANOVICH
Title or Position: PROGRAM DIRECTOR
Credential: RN
Phone: 617-513-2158