Organization
GOLDEN AGE NURSING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES B. MCCARTNEY (OWNER/MANAGER)
(318) 992-4175
Entity
Organization
Contact information
Practice address
5877 AIMWELL RD., JENA, LA 71342-3020
(318) 992-4175
(318) 992-4177
Mailing address
PO BOX 3020, JENA, LA 71342-3020
(318) 992-4175
(318) 992-4177
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
481
LA
314000000X
Skilled Nursing Facility
481
LA
332BN1400X
Nursing Facility Supplies (DME)
481
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1520250
—
LA
05
—
1684317
—
LA
Enumeration date
09/21/2006
Last updated
09/23/2008
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