MEDICARE: GOLDEN YEARS HEALTH CARE SERVICES LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1124571930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN YEARS HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	10 BIRITZ DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-2813
Country	:	US
Telephone Number	:	314-566-9120
Fax Number	:	314-942-3227

Provider Business Practice Location Address
First Line	:	10 BIRITZ DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-2813
Country	:	US
Telephone Number	:	314-566-9120
Fax Number	:	314-942-3227

Authorized Official
Title or Position	:	OWNER
Name	:	MARLA HUNTER-SAWYER
Credential	:
Telephone Number	:	314-566-9120

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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