Provider Demographics
NPI:1932428570
Name:GOLDEN AGE HOME HEALTH SERVICE , LLC.
Entity Type:Organization
Organization Name:GOLDEN AGE HOME HEALTH SERVICE , LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-332-4655
Mailing Address - Street 1:3850 SULLIVANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-4327
Mailing Address - Country:US
Mailing Address - Phone:614-351-8351
Mailing Address - Fax:
Practice Address - Street 1:3850 SULLIVANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-4327
Practice Address - Country:US
Practice Address - Phone:614-351-8351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health