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General NPI Number Information
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NPI Number | 1306182183
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Entity Type | Organization
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Legal Business Name | GOLDEN YEARS LLC
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Dates
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Enumeration Date | 12/22/2012
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Last Update Date | 12/22/2012
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Provider Practice Location Address
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Address Line | 205 POWELL PL
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City | BRENTWOOD
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State | TN
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Zip | 37027-7522
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Country | US
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Telephone | 615-354-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 205 POWELL PL
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City | BRENTWOOD
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State | TN
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Zip | 37027-7522
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Country | US
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Telephone | 615-369-0614
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Fax | 615-369-0615
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Authorized Official
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Title or Position | CEO
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Name | TYPHANEE FITZGERALD
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Credential |
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Telephone | 615-426-1540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | I000000012172
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License Number State | TN
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