=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609758168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN YEARS CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 07/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7870 BROADWAY STE A
-----------------------------------------------------
City | MERRILLVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46410-5542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-789-8993
-----------------------------------------------------
Fax | 219-264-3733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7870 BROADWAY STE A
-----------------------------------------------------
City | MERRILLVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46410-5542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-789-8993
-----------------------------------------------------
Fax | 219-264-3733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. JASMINE HOPKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 219-771-6824
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------