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General NPI Number Information
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NPI Number | 1366685281
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Entity Type | Organization
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Legal Business Name | GOLDEN YEARS SENIOR CARE HOME LLC
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 7479 BETTY ST
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City | WINTER PARK
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State | FL
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Zip | 32792-7569
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Country | US
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Telephone | 407-715-7049
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Fax | 407-622-6489
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Provider Business Mailing Address
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Address Line | 7479 BETTY ST
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City | WINTER PARK
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State | FL
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Zip | 32792-7569
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Country | US
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Telephone | 407-715-7049
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Fax | 407-622-6489
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Authorized Official
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Title or Position | OWNER CAREGIVER
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Name | MS. SANDRA LEE CRESONG
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Credential |
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Telephone | 407-715-7049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL11558
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License Number State | FL
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