Provider Demographics
NPI:1932346830
Name:GOLDEN AGE ADULT SERVICES CORPORATION
Entity Type:Organization
Organization Name:GOLDEN AGE ADULT SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-693-0700
Mailing Address - Street 1:21 CANDLE LN
Mailing Address - Street 2:
Mailing Address - City:E BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 CANDLE LN
Practice Address - Street 2:
Practice Address - City:E BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3202
Practice Address - Country:US
Practice Address - Phone:516-693-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR08972100163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty