Provider Demographics
NPI:1871829150
Name:GOLDEN YEARS ADULT FOSTER CARE
Entity Type:Organization
Organization Name:GOLDEN YEARS ADULT FOSTER CARE
Other - Org Name:SHAWS AFC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-439-9478
Mailing Address - Street 1:1900 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-8315
Mailing Address - Country:US
Mailing Address - Phone:517-439-9478
Mailing Address - Fax:517-439-9478
Practice Address - Street 1:1885 OSSEO RD S
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MI
Practice Address - Zip Code:49266-9643
Practice Address - Country:US
Practice Address - Phone:517-523-4395
Practice Address - Fax:517-523-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS300011089311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3616301Medicaid
MI2214580Medicaid