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General NPI Number Information
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NPI Number | 1255617916
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Entity Type | Organization
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Legal Business Name | GOLDEN YEARS
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 371 RIVER NORTH BLVD
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City | MACON
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State | GA
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Zip | 31211-6017
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Country | US
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Telephone | 478-345-0162
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Fax | 478-745-1895
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Provider Business Mailing Address
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Address Line | 371 RIVER NORTH BLVD
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City | MACON
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State | GA
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Zip | 31211-6017
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Country | US
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Telephone | 478-365-0162
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Fax | 478-745-1895
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Authorized Official
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Title or Position | OWNER
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Name | MRS. RUBY F WIMGERLY
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Credential |
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Telephone | 478-743-3587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 084-R-0412
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 084-R-0412
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License Number State | GA
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