=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578448437
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME SUITE HOME PLUS LLC D.B.A. GOLDEN BOOMERS HOME PLUS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2025
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 124 N DERBY AVE
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67037-1441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-215-0060
-----------------------------------------------------
Fax | 316-364-4235
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 N DERBY AVE
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67037-1441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-215-0060
-----------------------------------------------------
Fax | 316-364-4235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | THUY NGOC NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 985-215-0060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------