Provider Demographics
NPI:1598362840
Name:GOLDEN AGE HOME CARE
Entity Type:Organization
Organization Name:GOLDEN AGE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:POMMELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-334-8633
Mailing Address - Street 1:12706 MUTINY LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-8420
Mailing Address - Country:US
Mailing Address - Phone:832-334-8633
Mailing Address - Fax:
Practice Address - Street 1:12706 MUTINY LN
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-8420
Practice Address - Country:US
Practice Address - Phone:832-334-8633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility