Provider Demographics
NPI:1407372329
Name:GOLDEN AGE SENIOR CARE OF DESERT SPRINGS, LLC
Entity Type:Organization
Organization Name:GOLDEN AGE SENIOR CARE OF DESERT SPRINGS, LLC
Other - Org Name:SUNRIDGE AT DESERT SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-521-7600
Mailing Address - Street 1:5555 W GRANDE MARKET DR STE A
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8403
Mailing Address - Country:US
Mailing Address - Phone:920-574-3833
Mailing Address - Fax:920-574-3850
Practice Address - Street 1:5901 BANDOLERO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6662
Practice Address - Country:US
Practice Address - Phone:915-842-0900
Practice Address - Fax:915-842-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144733310400000X
311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)