Provider Demographics
NPI:1003193798
Name:GOLDEN AGE SENIOR CARE OF PALISADES, LLC
Entity Type:Organization
Organization Name:GOLDEN AGE SENIOR CARE OF PALISADES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-521-7600
Mailing Address - Street 1:125 S WACKER DR
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-4424
Mailing Address - Country:US
Mailing Address - Phone:312-521-7600
Mailing Address - Fax:312-357-1611
Practice Address - Street 1:1831 MURCHISON DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2917
Practice Address - Country:US
Practice Address - Phone:915-533-8271
Practice Address - Fax:915-533-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility