Provider Demographics
NPI:1407190697
Name:GOLDEN YEARS HOME CARE OF INDIANA
Entity Type:Organization
Organization Name:GOLDEN YEARS HOME CARE OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:812-822-0145
Mailing Address - Street 1:4101 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5539
Mailing Address - Country:US
Mailing Address - Phone:812-822-0145
Mailing Address - Fax:812-822-0152
Practice Address - Street 1:4101 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5539
Practice Address - Country:US
Practice Address - Phone:812-822-0145
Practice Address - Fax:812-822-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09-012240-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health