Provider Demographics
NPI:1003358979
Name:NSH GOLDEN AGE LLC
Entity Type:Organization
Organization Name:NSH GOLDEN AGE LLC
Other - Org Name:TOMAHAWK HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HOEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-962-5250
Mailing Address - Street 1:5150 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5474
Mailing Address - Country:US
Mailing Address - Phone:414-962-5250
Mailing Address - Fax:414-962-5251
Practice Address - Street 1:720 E KING RD
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-1513
Practice Address - Country:US
Practice Address - Phone:715-453-2164
Practice Address - Fax:715-453-1066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NSHG WISCONSIN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-09
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility