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General NPI Number Information
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NPI Number | 1578560272
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Entity Type | Organization
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Legal Business Name | GOLDEN AGE HOSPICE, INC
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 908 S.W. 107TH ST.
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-5244
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Country | US
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Telephone | 405-605-7787
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Fax | 405-605-7789
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Provider Business Mailing Address
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Address Line | 908 S.W. 107TH ST.
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-5244
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Country | US
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Telephone | 405-605-7787
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Fax | 405-605-7789
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MRS. LATONYA FAYE ROBINSON
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Credential | LCSW
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Telephone | 405-605-7787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 4186
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License Number State | OK
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