Healthcare Provider Details

I. General information

NPI: 1588745335
Provider Name (Legal Business Name): GOLDEN AGE OF WELSH, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S SIMMONS ST
WELSH LA
70591-5028
US

IV. Provider business mailing address

410 S SIMMONS ST
WELSH LA
70591-5028
US

V. Phone/Fax

Practice location:
  • Phone: 337-734-2555
  • Fax: 337-734-2024
Mailing address:
  • Phone: 337-734-2555
  • Fax: 337-734-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number733
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number733
License Number StateLA

VIII. Authorized Official

Name: MR. JAMES AARON JOUBERT JR.
Title or Position: OWNER
Credential:
Phone: 337-734-2555