Provider Demographics
NPI:1114284791
Name:GOLDEN YEARS COMPANION CARE
Entity Type:Organization
Organization Name:GOLDEN YEARS COMPANION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-447-0034
Mailing Address - Street 1:1300 S WABASH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2547
Mailing Address - Country:US
Mailing Address - Phone:312-447-0034
Mailing Address - Fax:312-447-0036
Practice Address - Street 1:1300 S WABASH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2547
Practice Address - Country:US
Practice Address - Phone:312-447-0034
Practice Address - Fax:312-447-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000650253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care