Provider Demographics
NPI:1164631487
Name:EVELYN STANSBARGER
Entity Type:Organization
Organization Name:EVELYN STANSBARGER
Other - Org Name:GOLDEN YEARS CARE HOME, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANSBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-612-1955
Mailing Address - Street 1:6524 E ODESSA ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1060
Mailing Address - Country:US
Mailing Address - Phone:480-612-1955
Mailing Address - Fax:480-924-3168
Practice Address - Street 1:5632 E FAIRBROOK ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-5571
Practice Address - Country:US
Practice Address - Phone:480-612-1955
Practice Address - Fax:480-924-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH5964310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZALH5964OtherASSISTED GROUP HOME