Provider Demographics
NPI:1417497306
Name:GOLDEN YEARS HEALTHCARE LLC
Entity Type:Organization
Organization Name:GOLDEN YEARS HEALTHCARE LLC
Other - Org Name:GOLDEN YEARS HOME & ADULT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-326-3585
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:MARKS
Mailing Address - State:MS
Mailing Address - Zip Code:38646-0372
Mailing Address - Country:US
Mailing Address - Phone:662-326-0449
Mailing Address - Fax:662-326-3586
Practice Address - Street 1:207 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MARKS
Practice Address - State:MS
Practice Address - Zip Code:38646-1212
Practice Address - Country:US
Practice Address - Phone:662-326-0449
Practice Address - Fax:662-326-3585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN YEARS HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-27
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1417497306Medicaid