Provider Demographics
NPI:1598541070
Name:CMZ GOLDEN YEARS LLC
Entity Type:Organization
Organization Name:CMZ GOLDEN YEARS LLC
Other - Org Name:GOLDEN YEARS OF RANDOLPH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-400-9322
Mailing Address - Street 1:W11451 COUNTY ROAD CF
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:WI
Mailing Address - Zip Code:53956-9626
Mailing Address - Country:US
Mailing Address - Phone:920-400-9322
Mailing Address - Fax:
Practice Address - Street 1:131 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:WI
Practice Address - Zip Code:53956-1309
Practice Address - Country:US
Practice Address - Phone:920-326-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility