Provider Demographics
NPI:1629501101
Name:OLDEN IS GOLDEN
Entity Type:Organization
Organization Name:OLDEN IS GOLDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA,MA,MT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:II
Authorized Official - Credentials:CNA,MA,MT
Authorized Official - Phone:239-850-1394
Mailing Address - Street 1:3304 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5397
Mailing Address - Country:US
Mailing Address - Phone:239-850-1394
Mailing Address - Fax:
Practice Address - Street 1:3304 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-5397
Practice Address - Country:US
Practice Address - Phone:239-850-1394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care