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General NPI Number Information
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NPI Number | 1942971999
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Entity Type | Organization
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Legal Business Name | GOLDEN AGE ASSISTED LIVING, INC.
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 6441 S RICHMOND AVE
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City | WILLOWBROOK
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State | IL
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Zip | 60527-1842
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Country | US
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Telephone | 630-774-3590
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Fax | 630-481-4992
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Provider Business Mailing Address
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Address Line | 6441 S RICHMOND AVE
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City | WILLOWBROOK
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State | IL
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Zip | 60527-1842
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Country | US
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Telephone | 630-774-3590
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Fax | 630-481-4992
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. DAMIR MISSBRENNER
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Credential |
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Telephone | 630-774-3590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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