MEDICARE: MY GOLDEN YEARS HOME CARE SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	24673601	PA

General Provider Information

NPI Number	:	1073931549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY GOLDEN YEARS HOME CARE SERVICES INC.

Provider Business Mailing Address
First Line	:	PO BOX 52113
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-7113
Country	:	US
Telephone Number	:	267-888-6240
Fax Number	:	215-839-1132

Provider Business Practice Location Address
First Line	:	8814 BLUE GRASS RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-1302
Country	:	US
Telephone Number	:	267-444-9049
Fax Number	:	215-839-1132

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EPHRAIM KELLY
Credential	:
Telephone Number	:	267-444-9049

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	04/02/2014

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