Provider Demographics
NPI:1790446524
Name:MY GOLDEN AGE MGT SERVICES LLC
Entity Type:Organization
Organization Name:MY GOLDEN AGE MGT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYERLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGULO
Authorized Official - Suffix:
Authorized Official - Credentials:CBHT
Authorized Official - Phone:786-608-2876
Mailing Address - Street 1:6825 JIMMY CARTER BLVD STE 1700
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1269
Mailing Address - Country:US
Mailing Address - Phone:786-608-2876
Mailing Address - Fax:
Practice Address - Street 1:6825 JIMMY CARTER BLVD STE 1700
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1269
Practice Address - Country:US
Practice Address - Phone:786-608-2876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management