=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962714691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN LIFE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2010
-----------------------------------------------------
Last Update Date | 11/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1218 MURFREESBORO ROAD SUITE 112
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-367-3899
-----------------------------------------------------
Fax | 615-367-3896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1218 MURFREESBORO RD STE 112
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37217-2440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-367-3899
-----------------------------------------------------
Fax | 615-367-3896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATIONS
-----------------------------------------------------
Name | PRIMUS ODILI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-367-3899
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1000000005635
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------