Provider Demographics
NPI:1609974765
Name:GOLDEN YEARS HOMECARE SPECIALIST INCORPORATED
Entity Type:Organization
Organization Name:GOLDEN YEARS HOMECARE SPECIALIST INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-873-2770
Mailing Address - Street 1:106 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLS POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75169-2041
Mailing Address - Country:US
Mailing Address - Phone:903-873-2770
Mailing Address - Fax:903-873-6291
Practice Address - Street 1:106 N 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-2041
Practice Address - Country:US
Practice Address - Phone:903-873-2770
Practice Address - Fax:903-873-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010730251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2120974Medicaid
TX2120974Medicaid