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General NPI Number Information
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NPI Number | 1073931549
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Entity Type | Organization
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Legal Business Name | MY GOLDEN YEARS HOME CARE SERVICES INC.
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 8814 BLUE GRASS RD
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1302
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Country | US
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Telephone | 267-444-9049
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Fax | 215-839-1132
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Provider Business Mailing Address
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Address Line | PO BOX 52113
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City | PHILADELPHIA
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State | PA
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Zip | 19115-7113
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Country | US
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Telephone | 267-888-6240
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Fax | 215-839-1132
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EPHRAIM KELLY
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Credential |
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Telephone | 267-444-9049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 24673601
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License Number State | PA
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