Healthcare Provider Details

I. General information

NPI: 1912061771
Provider Name (Legal Business Name): GOLDEN YEARS CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 4500 S SUITE 460
MURRAY UT
84107-3993
US

IV. Provider business mailing address

310 E 4500 S SUITE 460
MURRAY UT
84107-3993
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-2111
  • Fax: 801-747-2104
Mailing address:
  • Phone: 801-747-2111
  • Fax: 801-747-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateUT

VIII. Authorized Official

Name: ED DIERINGER
Title or Position: VICE PRESIDENT
Credential: PT
Phone: 801-747-2111