Provider Demographics
NPI:1306382023
Name:GOLDEN AGE HEALTHCARE LLC
Entity Type:Organization
Organization Name:GOLDEN AGE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:ETOAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-540-8723
Mailing Address - Street 1:14007 RIVER KEG DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6507
Mailing Address - Country:US
Mailing Address - Phone:713-540-8723
Mailing Address - Fax:
Practice Address - Street 1:14007 RIVER KEG DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6507
Practice Address - Country:US
Practice Address - Phone:713-540-8723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0Medicaid