Healthcare Provider Details

I. General information

NPI: 1932428570
Provider Name (Legal Business Name): GOLDEN AGE HOME HEALTH SERVICE , LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 SULLIVANT AVE
COLUMBUS OH
43228-4327
US

IV. Provider business mailing address

3850 SULLIVANT AVE
COLUMBUS OH
43228-4327
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 Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED DALLIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 614-332-4655