Healthcare Provider Details

I. General information

NPI: 1336681857
Provider Name (Legal Business Name): GOLDEN AGE HOME HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 W PIONEER PKWY STE 100B
ARLINGTON TX
76013-6398
US

IV. Provider business mailing address

1117 W PIONEER PKWY STE 100B
ARLINGTON TX
76013-6398
US

V. Phone/Fax

Practice location:
  • Phone: 817-617-8016
  • Fax: 817-459-3314
Mailing address:
  • Phone: 817-617-8016
  • Fax: 817-459-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AGNES STURGEON
Title or Position: ADMINISTRATOR
Credential:
Phone: 817-501-7727