Provider Demographics
NPI:1356428718
Name:GOLDEN AGE, INC.
Entity type:Organization
Organization Name:GOLDEN AGE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIRCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-856-2757
Mailing Address - Street 1:1915 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-3102
Mailing Address - Country:US
Mailing Address - Phone:641-856-2761
Mailing Address - Fax:641-856-2762
Practice Address - Street 1:1915 S 18TH ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-3102
Practice Address - Country:US
Practice Address - Phone:641-856-2761
Practice Address - Fax:641-856-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA040983385H00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA65257OtherBCBS PROVIDER #
IA0168922Medicaid
IA0809376Medicaid
IA165257Medicare Oscar/Certification