Healthcare Provider Details

I. General information

NPI: 1609974765
Provider Name (Legal Business Name): GOLDEN YEARS HOMECARE SPECIALIST INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N 4TH ST
WILLS POINT TX
75169-2041
US

IV. Provider business mailing address

106 N 4TH ST
WILLS POINT TX
75169-2041
US

V. Phone/Fax

Practice location:
  • Phone: 903-873-2770
  • Fax: 903-873-6291
Mailing address:
  • Phone: 903-873-2770
  • Fax: 903-873-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number010730
License Number StateTX

VIII. Authorized Official

Name: MR. CALVIN CUNIGAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-873-2770