Provider Demographics
NPI:1972901130
Name:GOLDEN YEARS
Entity Type:Organization
Organization Name:GOLDEN YEARS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-846-0146
Mailing Address - Street 1:48 A HUBBARD ROAD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98849
Mailing Address - Country:US
Mailing Address - Phone:509-846-0146
Mailing Address - Fax:509-846-0146
Practice Address - Street 1:48A HUBBARD RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:WA
Practice Address - Zip Code:98849-9650
Practice Address - Country:US
Practice Address - Phone:509-846-0146
Practice Address - Fax:509-846-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA597900311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home