Provider Demographics
NPI:1013451202
Name:GOLDEN YEARS ADULT DAY CARE
Entity Type:Organization
Organization Name:GOLDEN YEARS ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PETTENGILL
Authorized Official - Suffix:
Authorized Official - Credentials:CRMA,MA,CNA-M
Authorized Official - Phone:207-730-0968
Mailing Address - Street 1:24 HOYT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-1710
Mailing Address - Country:US
Mailing Address - Phone:207-850-4793
Mailing Address - Fax:207-850-1184
Practice Address - Street 1:24 HOYT ST
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1710
Practice Address - Country:US
Practice Address - Phone:207-850-4793
Practice Address - Fax:207-850-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEADS38641261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care