MEDICARE: GOLDEN YEARS HOME HEALTH CARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1942960588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN YEARS HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	5960 CARSON MICHAEL AVE APT 202
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-4421
Country	:	US
Telephone Number	:	614-432-9391
Fax Number	:

Provider Business Practice Location Address
First Line	:	5960 CARSON MICHAEL AVE APT 202
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-4421
Country	:	US
Telephone Number	:	614-432-9391
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF NURSING
Name	:	MS. SAYNAB MOHAMUD GANI
Credential	:	RN
Telephone Number	:	614-432-9391

Provider Enumeration Date	:	12/22/2021
Last Update Date	:	12/22/2021

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