Healthcare Provider Details

I. General information

NPI: 1619233905
Provider Name (Legal Business Name): ENJOY GOLDEN AGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SAN PAULO CT
ARLINGTON TX
76012-2751
US

IV. Provider business mailing address

3200 SAN PAULO CT
ARLINGTON TX
76012-2751
US

V. Phone/Fax

Practice location:
  • Phone: 817-333-9874
  • Fax:
Mailing address:
  • Phone:
  • 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: MS. LOAN NGUYEN
Title or Position: CEO
Credential:
Phone: 817-333-9874