MEDICARE: GOLDEN YEARS SENIOR ACTIVITY CENTER CORP.

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	376J00000X	Homemaker	233661	FL
2	372600000X	Adult Companion	233661	FL
3	372500000X	Chore Provider	233661	FL
4	261QA0600X	Adult Day Care Clinic/Center	9274	FL

General Provider Information

NPI Number	:	1205277373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN YEARS SENIOR ACTIVITY CENTER CORP.

Provider Business Mailing Address
First Line	:	1133 BAL HARBOR BLVD
Second Line	:	STE 1135
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-6577
Country	:	US
Telephone Number	:	941-655-8736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 BAL HARBOR BLVD
Second Line	:	STE 1135
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-6577
Country	:	US
Telephone Number	:	941-655-8736
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	CARLOS J MOREJON
Credential	:
Telephone Number	:	941-655-8736

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	10/03/2014

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