Provider Demographics
NPI:1457477077
Name:GOLDEN YEARS ADULT DAY CARE CENTER
Entity Type:Organization
Organization Name:GOLDEN YEARS ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYUBOV
Authorized Official - Middle Name:
Authorized Official - Last Name:ILIACHINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-782-4112
Mailing Address - Street 1:1225 MCBRIDE AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3813
Mailing Address - Country:US
Mailing Address - Phone:973-783-4112
Mailing Address - Fax:973-782-4116
Practice Address - Street 1:1225 MCBRIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3812
Practice Address - Country:US
Practice Address - Phone:973-783-4112
Practice Address - Fax:973-782-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPQGG17261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8797706Medicaid