Provider Demographics
NPI:1376894238
Name:GOLDEN AGE CAREGIVERS
Entity Type:Organization
Organization Name:GOLDEN AGE CAREGIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACCIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROP
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:515-661-3836
Mailing Address - Street 1:8527 UNIVERSITY BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-1069
Mailing Address - Country:US
Mailing Address - Phone:515-661-3836
Mailing Address - Fax:
Practice Address - Street 1:8527 UNIVERSITY BLVD STE 9
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-1069
Practice Address - Country:US
Practice Address - Phone:515-661-3836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA489DLC-440147374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty