Healthcare Provider Details

I. General information

NPI: 1255426250
Provider Name (Legal Business Name): GOLDEN HOUR SR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UINTA DR SUITE A
GREEN RIVER WY
82935-5005
US

IV. Provider business mailing address

550 UINTA DRIVE SUITE A
GREEN RIVER WY
82935-5005
US

V. Phone/Fax

Practice location:
  • Phone: 307-872-3223
  • Fax: 307-872-3225
Mailing address:
  • Phone: 307-872-3223
  • Fax: 307-872-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateWY

VIII. Authorized Official

Name: MR. EDWIN DEAN MAKIE
Title or Position: DIRECTOR GOLDEN HOUR SR CENTER
Credential:
Phone: 307-872-3223