Provider Demographics
NPI:1003674854
Name:GOLDEN YEARS GERIATRIC MEDICINE
Entity Type:Organization
Organization Name:GOLDEN YEARS GERIATRIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZE OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMIESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-225-1868
Mailing Address - Street 1:11 CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1613
Mailing Address - Country:US
Mailing Address - Phone:978-987-1170
Mailing Address - Fax:
Practice Address - Street 1:11 CASCADE AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1613
Practice Address - Country:US
Practice Address - Phone:978-987-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility