MEDICARE: GOLDEN YEARS SENIORCARE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255809927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN YEARS SENIORCARE INC.

Provider Business Mailing Address
First Line	:	2650 FARLEY ST
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-2327
Country	:	US
Telephone Number	:	678-235-1982
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 FARLEY ST
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-2327
Country	:	US
Telephone Number	:	678-235-1982
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JENNIFER STOVALL
Credential	:	CERTIFITED NURSE AID
Telephone Number	:	678-235-1982

Provider Enumeration Date	:	11/11/2018
Last Update Date	:	11/11/2018

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