MEDICARE: GOLDEN AGE PARENTAL CARE LLC

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	3747P1801X	Personal Care Attendant
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1538977103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN AGE PARENTAL CARE LLC

Provider Business Mailing Address
First Line	:	247 E SOUTHWEST PKWY APT 605
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-8728
Country	:	US
Telephone Number	:	214-355-8628
Fax Number	:

Provider Business Practice Location Address
First Line	:	247 E SOUTHWEST PKWY APT 605
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-8728
Country	:	US
Telephone Number	:	214-355-8628
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JULIUS ONYENJIUWA MADAGU
Credential	:	MD
Telephone Number	:	214-355-8628

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	12/27/2024

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