Healthcare Provider Details

I. General information

NPI: 1790697258
Provider Name (Legal Business Name): GOLDEN YEARS FHA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13306 NE 3RD AVE
VANCOUVER WA
98685-2691
US

IV. Provider business mailing address

13306 NE 3RD AVE
VANCOUVER WA
98685-2691
US

V. Phone/Fax

Practice location:
  • Phone: 360-521-7065
  • Fax:
Mailing address:
  • Phone: 360-521-7065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: LILIA CONOVALOV
Title or Position: MANAGER
Credential:
Phone: 360-521-7065