Provider Demographics
NPI:1255617916
Name:GOLDEN YEARS
Entity type:Organization
Organization Name:GOLDEN YEARS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:F
Authorized Official - Last Name:WIMGERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-743-3587
Mailing Address - Street 1:371 RIVER NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-6017
Mailing Address - Country:US
Mailing Address - Phone:478-365-0162
Mailing Address - Fax:478-745-1895
Practice Address - Street 1:371 RIVER NORTH BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-6017
Practice Address - Country:US
Practice Address - Phone:478-345-0162
Practice Address - Fax:478-745-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA084-R-0412251J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care