Provider Demographics
NPI:1164605234
Name:GOLDEN YEARS CARE LLC
Entity Type:Organization
Organization Name:GOLDEN YEARS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-845-3332
Mailing Address - Street 1:1027 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2359
Mailing Address - Country:US
Mailing Address - Phone:732-845-3332
Mailing Address - Fax:732-845-3339
Practice Address - Street 1:20 JACKSON ST
Practice Address - Street 2:1A
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2476
Practice Address - Country:US
Practice Address - Phone:732-845-3332
Practice Address - Fax:732-845-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ13001261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0147567Medicaid