Healthcare Provider Details

I. General information

NPI: 1184181851
Provider Name (Legal Business Name): GOLDEN YEARS PERSONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S VALLEY VIEW BLVD STE 5
LAS VEGAS NV
89102-0116
US

IV. Provider business mailing address

4627 PIONEER AVE
LAS VEGAS NV
89102-8018
US

V. Phone/Fax

Practice location:
  • Phone: 702-909-5037
  • Fax: 702-909-5031
Mailing address:
  • Phone: 702-245-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TANIA B CASTRO
Title or Position: OWNER
Credential:
Phone: 702-245-7417