Provider Demographics
NPI:1588745335
Name:GOLDEN AGE OF WELSH, L.L.C.
Entity type:Organization
Organization Name:GOLDEN AGE OF WELSH, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:JOUBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:337-734-2555
Mailing Address - Street 1:410 S SIMMONS ST
Mailing Address - Street 2:
Mailing Address - City:WELSH
Mailing Address - State:LA
Mailing Address - Zip Code:70591-5028
Mailing Address - Country:US
Mailing Address - Phone:337-734-2555
Mailing Address - Fax:337-734-2024
Practice Address - Street 1:410 S SIMMONS ST
Practice Address - Street 2:
Practice Address - City:WELSH
Practice Address - State:LA
Practice Address - Zip Code:70591-5028
Practice Address - Country:US
Practice Address - Phone:337-734-2555
Practice Address - Fax:337-734-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA733313M00000X, 314000000X
332BP3500X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1513539Medicaid
LA195522Medicare ID - Type UnspecifiedPROVIDER NUMBER
LA1325550001Medicare NSC