Healthcare Provider Details

I. General information

NPI: 1851708713
Provider Name (Legal Business Name): GOLDEN AGE DAY CARE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 INDUSTRIAL MILE RD
COLUMBUS OH
43228-2411
US

IV. Provider business mailing address

464 INDUSTRIAL MILE RD
COLUMBUS OH
43228-2411
US

V. Phone/Fax

Practice location:
  • Phone: 614-351-8351
  • Fax:
Mailing address:
  • Phone: 614-351-8351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MOHAMED DALLIN
Title or Position: PRESIDENT
Credential:
Phone: 614-351-8351