Provider Demographics
NPI:1104872209
Name:GOLDEN AGE HEALTH, INC
Entity type:Organization
Organization Name:GOLDEN AGE HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CHAIRMAN/CFO
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOWAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-692-1255
Mailing Address - Street 1:934 SW 107TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5244
Mailing Address - Country:US
Mailing Address - Phone:405-692-1255
Mailing Address - Fax:405-692-7522
Practice Address - Street 1:934 SW 107TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-5244
Practice Address - Country:US
Practice Address - Phone:405-692-1255
Practice Address - Fax:405-692-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7517251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377550Medicare Oscar/Certification