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General NPI Number Information
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NPI Number | 1932428570
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Entity Type | Organization
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Legal Business Name | GOLDEN AGE HOME HEALTH SERVICE , LLC.
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 3850 SULLIVANT AVE
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City | COLUMBUS
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State | OH
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Zip | 43228-4327
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Country | US
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Telephone | 614-351-8351
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Fax |
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Provider Business Mailing Address
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Address Line | 3850 SULLIVANT AVE
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City | COLUMBUS
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State | OH
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Zip | 43228-4327
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Country | US
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Telephone | 614-351-8351
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MOHAMED DALLIN
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Credential |
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Telephone | 614-332-4655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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