Provider Demographics
NPI:1366989923
Name:GOLDEN YEARS AND MORE ASSISTING LIVING
Entity type:Organization
Organization Name:GOLDEN YEARS AND MORE ASSISTING LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:B
Authorized Official - Last Name:CALUBAQUIB
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN
Authorized Official - Phone:703-791-0058
Mailing Address - Street 1:13114 CANOVA DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-7840
Mailing Address - Country:US
Mailing Address - Phone:703-791-0058
Mailing Address - Fax:703-563-9476
Practice Address - Street 1:13114 CANOVA DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-7840
Practice Address - Country:US
Practice Address - Phone:703-791-0058
Practice Address - Fax:703-563-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAALF1039413104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances