Provider Demographics
NPI:1750191623
Name:OUR GOLDEN LIFE LLC
Entity type:Organization
Organization Name:OUR GOLDEN LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LIFE
Authorized Official - Middle Name:O
Authorized Official - Last Name:AGYARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-533-7437
Mailing Address - Street 1:11944 BENTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-6159
Mailing Address - Country:US
Mailing Address - Phone:240-533-7437
Mailing Address - Fax:
Practice Address - Street 1:11944 BENTON LAKE RD
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-6159
Practice Address - Country:US
Practice Address - Phone:240-522-7437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care