Provider Demographics
NPI:1922644459
Name:GOLDEN YEARS RESIDENTIAL CARE FACILITY, LLC
Entity Type:Organization
Organization Name:GOLDEN YEARS RESIDENTIAL CARE FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-480-9021
Mailing Address - Street 1:8920 LOGGERS MILL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143-5423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8920 LOGGERS MILL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89143-5423
Practice Address - Country:US
Practice Address - Phone:702-202-6475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100539474Medicaid