Provider Demographics
NPI:1205277373
Name:GOLDEN YEARS SENIOR ACTIVITY CENTER CORP.
Entity type:Organization
Organization Name:GOLDEN YEARS SENIOR ACTIVITY CENTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOREJON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-655-8736
Mailing Address - Street 1:1133 BAL HARBOR BLVD
Mailing Address - Street 2:STE 1135
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-6577
Mailing Address - Country:US
Mailing Address - Phone:941-655-8736
Mailing Address - Fax:
Practice Address - Street 1:1133 BAL HARBOR BLVD
Practice Address - Street 2:STE 1135
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-6577
Practice Address - Country:US
Practice Address - Phone:941-655-8736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233661376J00000X, 372600000X, 372500000X
FL9274261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty