Provider Demographics
NPI:1437293594
Name:GOLDEN YEARS FCH
Entity Type:Organization
Organization Name:GOLDEN YEARS FCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:COX
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:919-730-7405
Mailing Address - Street 1:410 MONTFORD DR
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-4624
Mailing Address - Country:US
Mailing Address - Phone:336-597-4270
Mailing Address - Fax:336-597-4270
Practice Address - Street 1:410 MONTFORD DR
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4624
Practice Address - Country:US
Practice Address - Phone:336-597-4270
Practice Address - Fax:336-597-4270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL073011310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7809008Medicaid