MEDICARE: GOLDEN AGE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1104041839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN AGE SERVICES

Provider Business Mailing Address
First Line	:	2432 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-1636
Country	:	US
Telephone Number	:	614-332-4655
Fax Number	:

Provider Business Practice Location Address
First Line	:	2432 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-1636
Country	:	US
Telephone Number	:	614-332-4655
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MOHAMUD T DALLIN
Credential	:
Telephone Number	:	614-332-4655

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	08/22/2020

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Directions to “GOLDEN AGE SERVICES ” Practice Location

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