Provider Demographics
NPI:1730744889
Name:GOLDEN AGE ASSISTED LIVING,LLC
Entity type:Organization
Organization Name:GOLDEN AGE ASSISTED LIVING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DENISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPORALIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-312-2798
Mailing Address - Street 1:17176 W WATKINS ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1718
Mailing Address - Country:US
Mailing Address - Phone:623-312-2798
Mailing Address - Fax:623-399-6561
Practice Address - Street 1:17176 W WATKINS ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1718
Practice Address - Country:US
Practice Address - Phone:623-312-2798
Practice Address - Fax:623-399-6561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home