Provider Demographics
NPI:1366685281
Name:GOLDEN YEARS SENIOR CARE HOME LLC
Entity Type:Organization
Organization Name:GOLDEN YEARS SENIOR CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CAREGIVER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CRESONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-715-7049
Mailing Address - Street 1:7479 BETTY ST
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7569
Mailing Address - Country:US
Mailing Address - Phone:407-715-7049
Mailing Address - Fax:407-622-6489
Practice Address - Street 1:7479 BETTY ST
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7569
Practice Address - Country:US
Practice Address - Phone:407-715-7049
Practice Address - Fax:407-622-6489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11558310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility