Healthcare Provider Details

I. General information

NPI: 1396983003
Provider Name (Legal Business Name): GOLDEN YEARS ADVOCATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26677 W. 12 MILE RD.
SOUTHFIELD MI
48034
US

IV. Provider business mailing address

26677 W. 12 MILE RD.
SOUTHFIELD MI
48034
US

V. Phone/Fax

Practice location:
  • Phone: 248-447-7955
  • Fax: 248-447-7956
Mailing address:
  • Phone: 248-447-7955
  • Fax: 248-447-7956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TONY BURNETT
Title or Position: MANAGING MEMBER
Credential:
Phone: 313-790-0701