Provider Demographics
NPI:1962509505
Name:GOLDEN AGE OF LEXINGTON, INC.
Entity Type:Organization
Organization Name:GOLDEN AGE OF LEXINGTON, INC.
Other - Org Name:ALSTON BROOK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-841-4920
Mailing Address - Street 1:4748 OLD SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-7827
Mailing Address - Country:US
Mailing Address - Phone:336-956-1132
Mailing Address - Fax:336-956-3112
Practice Address - Street 1:4748 OLD SALISBURY RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-7827
Practice Address - Country:US
Practice Address - Phone:336-956-1132
Practice Address - Fax:336-956-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH00094314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC345066Medicare Oscar/Certification