=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376190561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MY GOLDEN YEARS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2019
-----------------------------------------------------
Last Update Date | 07/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 RAY RD
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32351-7621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-556-8952
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 RAY RD
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32351-7621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-556-8952
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BARBARA ALEXANDER-MCFARLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-556-8952
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------