Provider Demographics
NPI:1831693936
Name:GOLDEN YEARS NURSING HOME, INC.
Entity type:Organization
Organization Name:GOLDEN YEARS NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANKEVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-275-6103
Mailing Address - Street 1:270 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:53184-9526
Mailing Address - Country:US
Mailing Address - Phone:262-275-6103
Mailing Address - Fax:
Practice Address - Street 1:611 HARMONY DR
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-8800
Practice Address - Country:US
Practice Address - Phone:262-275-6103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN YEARS NURSING HOME, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility