Provider Demographics
NPI:1073854725
Name:GOLDEN YEARS HOME CARE LLC
Entity Type:Organization
Organization Name:GOLDEN YEARS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:318-344-2530
Mailing Address - Street 1:2707 S EMPORIA ST
Mailing Address - Street 2:1103
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-4772
Mailing Address - Country:US
Mailing Address - Phone:318-344-2530
Mailing Address - Fax:
Practice Address - Street 1:2707 S EMPORIA ST
Practice Address - Street 2:1103
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67216-4772
Practice Address - Country:US
Practice Address - Phone:318-344-2530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6822662253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care