Provider Demographics
NPI:1679560957
Name:GOLDEN AGE HEALTH CARE, INC.
Entity Type:Organization
Organization Name:GOLDEN AGE HEALTH CARE, INC.
Other - Org Name:ALLEVE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-878-8772
Mailing Address - Street 1:2801 N KICKAPOO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1709
Mailing Address - Country:US
Mailing Address - Phone:405-878-8775
Mailing Address - Fax:405-878-8776
Practice Address - Street 1:2801 N KICKAPOO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1709
Practice Address - Country:US
Practice Address - Phone:405-878-8775
Practice Address - Fax:405-878-8776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7455251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200095690AMedicaid
OK377538Medicare ID - Type UnspecifiedPROVIDER NUMBER