Provider Demographics
NPI:1275922312
Name:GOLDEN AGE TRANSPORT LLC
Entity Type:Organization
Organization Name:GOLDEN AGE TRANSPORT LLC
Other - Org Name:GOLDEN AGE TRANSPORTATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-635-9619
Mailing Address - Street 1:10757 S RIVER FRONT PKWY
Mailing Address - Street 2:#110
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3545
Mailing Address - Country:US
Mailing Address - Phone:801-635-9619
Mailing Address - Fax:
Practice Address - Street 1:10757 S RIVER FRONT PKWY
Practice Address - Street 2:#110
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3545
Practice Address - Country:US
Practice Address - Phone:801-635-9619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)