Provider Demographics
NPI:1609932193
Name:GOLDEN YEARS CARE HOME, LLC
Entity type:Organization
Organization Name:GOLDEN YEARS CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:STANSBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-396-4490
Mailing Address - Street 1:7312 E JASMINE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-2930
Mailing Address - Country:US
Mailing Address - Phone:480-396-4490
Mailing Address - Fax:480-396-4490
Practice Address - Street 1:7312 E JASMINE ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-2930
Practice Address - Country:US
Practice Address - Phone:480-396-4490
Practice Address - Fax:480-396-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ789802311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home