Healthcare Provider Details

I. General information

NPI: 1013451202
Provider Name (Legal Business Name): GOLDEN YEARS ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOYT ST
SPRINGVALE ME
04083-1710
US

IV. Provider business mailing address

24 HOYT ST
SPRINGVALE ME
04083-1710
US

V. Phone/Fax

Practice location:
  • Phone: 207-850-4793
  • Fax: 207-850-1184
Mailing address:
  • Phone: 207-850-4793
  • Fax: 207-850-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADS38641
License Number StateME

VIII. Authorized Official

Name: LORRIE ANN PETTENGILL
Title or Position: ADMINISTRATOR
Credential: CRMA,MA,CNA-M
Phone: 207-730-0968