MEDICARE: GOLDENEDGE HC

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

General Provider Information

NPI Number	:	1174021000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDENEDGE HC

Provider Business Mailing Address
First Line	:	18335 ALL OAK TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-3490
Country	:	US
Telephone Number	:	361-228-0965
Fax Number	:

Provider Business Practice Location Address
First Line	:	18335 ALL OAK TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-3490
Country	:	US
Telephone Number	:	361-228-0965
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JADESOLA OMOBOLAJI AJIBOYE
Credential	:
Telephone Number	:	361-228-0965

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	01/25/2018

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Directions to “GOLDENEDGE HC ” Practice Location

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