MEDICARE: GOLDEN AGE HEALTH, INC

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	251E00000X	Home Health Agency	7517	OK

General Provider Information

NPI Number	:	1104872209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN AGE HEALTH, INC

Provider Business Mailing Address
First Line	:	934 SW 107TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-5244
Country	:	US
Telephone Number	:	405-692-1255
Fax Number	:	405-692-7522

Provider Business Practice Location Address
First Line	:	934 SW 107TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-5244
Country	:	US
Telephone Number	:	405-692-1255
Fax Number	:	405-692-7522

Authorized Official
Title or Position	:	FOUNDER/CHAIRMAN/CFO
Name	:	NATHAN A SOWAH
Credential	:
Telephone Number	:	405-692-1255

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/13/2021

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