MEDICARE: GOLDEN AGE RAINBOW SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2065X	Child Physical Disabilities Respite Care	HC2275	NC
2	251E00000X	Home Health Agency	HC2275	NC
3	3416L0300X	Land Ambulance	HC2275	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093868846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN AGE RAINBOW SERVICES INC

Provider Business Mailing Address
First Line	:	1300 BAXTER STREET
Second Line	:	SUITE 240
City	:	CHARLOTTE
State	:	NC
Zip	:	28204
Country	:	US
Telephone Number	:	704-333-7583
Fax Number	:	704-333-7605

Provider Business Practice Location Address
First Line	:	1300 BAXTER ST
Second Line	:	SUITE 240
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3053
Country	:	US
Telephone Number	:	704-333-7583
Fax Number	:	704-333-7605

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ACQUIRNETA DARNELL MCNAIR
Credential	:	CNA
Telephone Number	:	704-333-7583

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/11/2025

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Directions to “GOLDEN AGE RAINBOW SERVICES INC ” Practice Location

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