Provider Demographics
NPI:1598581035
Name:GOLDEN AGE FAMILY INC.
Entity type:Organization
Organization Name:GOLDEN AGE FAMILY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIGATU
Authorized Official - Middle Name:NEGEYA
Authorized Official - Last Name:KASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-999-6797
Mailing Address - Street 1:5500 EXECUTIVE CENTER DR STE 106
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8851
Mailing Address - Country:US
Mailing Address - Phone:704-999-6797
Mailing Address - Fax:704-931-5246
Practice Address - Street 1:5500 EXECUTIVE CENTER DR STE 106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8851
Practice Address - Country:US
Practice Address - Phone:704-999-6797
Practice Address - Fax:704-931-5246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOGISTICS EXPRESS BUSINESS SERVICE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker