Healthcare Provider Details

I. General information

NPI: 1376191205
Provider Name (Legal Business Name): GOLDEN AGE HH OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 E DOBKINS ST
DUBLIN TX
76446-2419
US

IV. Provider business mailing address

704 E DOBKINS ST
DUBLIN TX
76446-2419
US

V. Phone/Fax

Practice location:
  • Phone: 254-445-3370
  • Fax: 254-445-4276
Mailing address:
  • Phone: 254-445-3370
  • Fax: 254-445-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ERICH WAHL
Title or Position: CEO
Credential:
Phone: 936-262-3014