Provider Demographics
NPI:1255858627
Name:GOLDEN AGE GROUP, INC
Entity Type:Organization
Organization Name:GOLDEN AGE GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-277-9800
Mailing Address - Street 1:PO BOX 3978
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3978
Mailing Address - Country:US
Mailing Address - Phone:939-277-9800
Mailing Address - Fax:787-705-6414
Practice Address - Street 1:2100 TURQUESA ST
Practice Address - Street 2:BUCARE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:939-277-9800
Practice Address - Fax:787-705-6414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-27
Last Update Date:2017-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)