Provider Demographics
NPI:1073931549
Name:MY GOLDEN YEARS HOME CARE SERVICES INC.
Entity Type:Organization
Organization Name:MY GOLDEN YEARS HOME CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EPHRAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-444-9049
Mailing Address - Street 1:PO BOX 52113
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-7113
Mailing Address - Country:US
Mailing Address - Phone:267-888-6240
Mailing Address - Fax:215-839-1132
Practice Address - Street 1:8814 BLUE GRASS RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-1302
Practice Address - Country:US
Practice Address - Phone:267-444-9049
Practice Address - Fax:215-839-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA24673601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health