MEDICARE: GOLDEN AGE HOME HEALTH SERVICE , LLC.

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	:	1932428570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN AGE HOME HEALTH SERVICE , LLC.

Provider Business Mailing Address
First Line	:	3850 SULLIVANT AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-4327
Country	:	US
Telephone Number	:	614-351-8351
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 SULLIVANT AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-4327
Country	:	US
Telephone Number	:	614-351-8351
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MOHAMED DALLIN
Credential	:
Telephone Number	:	614-332-4655

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	09/01/2010

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