Provider Demographics
NPI:1508680877
Name:GOLDEN AGE PARENTAL CARE LLC
Entity type:Organization
Organization Name:GOLDEN AGE PARENTAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENDRIX
Authorized Official - Middle Name:
Authorized Official - Last Name:UDABOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-355-8628
Mailing Address - Street 1:1000 VALLEY RIDGE BLVD APT 62036203
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2955
Mailing Address - Country:US
Mailing Address - Phone:214-355-8628
Mailing Address - Fax:
Practice Address - Street 1:1000 VALLEY RIDGE BLDV
Practice Address - Street 2:6203
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077
Practice Address - Country:US
Practice Address - Phone:214-355-8628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care