Provider Demographics
NPI:1730457698
Name:GOLDEN AGE HOME HEALTH LLC
Entity Type:Organization
Organization Name:GOLDEN AGE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TUSHAR
Authorized Official - Middle Name:P
Authorized Official - Last Name:LOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-865-3470
Mailing Address - Street 1:1711 S STATE ROAD 135
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6480
Mailing Address - Country:US
Mailing Address - Phone:317-865-3470
Mailing Address - Fax:317-534-0545
Practice Address - Street 1:1711 S STATE ROAD 135
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6480
Practice Address - Country:US
Practice Address - Phone:317-865-3470
Practice Address - Fax:317-534-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health