Provider Demographics
NPI:1093868846
Name:GOLDEN AGE RAINBOW SERVICES INC
Entity Type:Organization
Organization Name:GOLDEN AGE RAINBOW SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ACQUIRNETA
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:MCNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:704-333-7583
Mailing Address - Street 1:1300 BAXTER STREET
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204
Mailing Address - Country:US
Mailing Address - Phone:704-333-7583
Mailing Address - Fax:704-333-7605
Practice Address - Street 1:1300 BAXTER ST
Practice Address - Street 2:SUITE 240
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3053
Practice Address - Country:US
Practice Address - Phone:704-333-7583
Practice Address - Fax:704-333-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2275251E00000X, 3416L0300X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Not Answered385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1093868846Medicaid