Healthcare Provider Details

I. General information

NPI: 1093868846
Provider Name (Legal Business Name): GOLDEN AGE RAINBOW SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 BAXTER ST SUITE 240
CHARLOTTE NC
28204-3053
US

IV. Provider business mailing address

1300 BAXTER STREET SUITE 240
CHARLOTTE NC
28204
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-7583
  • Fax: 704-333-7605
Mailing address:
  • Phone: 704-333-7583
  • Fax: 704-333-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2275
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberHC2275
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License NumberHC2275
License Number StateNC

VIII. Authorized Official

Name: MS. ACQUIRNETA DARNELL MCNAIR
Title or Position: OWNER
Credential: CNA
Phone: 704-333-7583