Provider Demographics
NPI:1104041839
Name:GOLDEN AGE SERVICES
Entity Type:Organization
Organization Name:GOLDEN AGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMUD
Authorized Official - Middle Name:T
Authorized Official - Last Name:DALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-332-4655
Mailing Address - Street 1:2432 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1636
Mailing Address - Country:US
Mailing Address - Phone:614-332-4655
Mailing Address - Fax:
Practice Address - Street 1:2432 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1636
Practice Address - Country:US
Practice Address - Phone:614-332-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services