Provider Demographics
NPI:1588606032
Name:GOLDEN AGE MOBILITY
Entity Type:Organization
Organization Name:GOLDEN AGE MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-637-7291
Mailing Address - Street 1:2877 TIMBER CREEK DR N
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1782
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:330-637-7293
Practice Address - Street 1:2576 MCCLEARY JACOBY RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1706
Practice Address - Country:US
Practice Address - Phone:330-637-7291
Practice Address - Fax:330-637-7293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2225863Medicaid