Provider Demographics
NPI:1376191205
Name:GOLDEN AGE HH OPCO LLC
Entity Type:Organization
Organization Name:GOLDEN AGE HH OPCO LLC
Other - Org Name:GOLDEN AGE HEALTHCARE RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-262-3014
Mailing Address - Street 1:704 E DOBKINS ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76446-2419
Mailing Address - Country:US
Mailing Address - Phone:254-445-3370
Mailing Address - Fax:254-445-4276
Practice Address - Street 1:704 E DOBKINS ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:TX
Practice Address - Zip Code:76446-2419
Practice Address - Country:US
Practice Address - Phone:254-445-3370
Practice Address - Fax:254-445-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility