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General NPI Number Information
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NPI Number | 1376191205
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Entity Type | Organization
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Legal Business Name | GOLDEN AGE HH OPCO LLC
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 704 E DOBKINS ST
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City | DUBLIN
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State | TX
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Zip | 76446-2419
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Country | US
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Telephone | 254-445-3370
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Fax | 254-445-4276
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Provider Business Mailing Address
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Address Line | 704 E DOBKINS ST
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City | DUBLIN
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State | TX
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Zip | 76446-2419
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Country | US
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Telephone | 254-445-3370
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Fax | 254-445-4276
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Authorized Official
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Title or Position | CEO
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Name | ERICH WAHL
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Credential |
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Telephone | 936-262-3014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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