Organization
GOLDEN AGE NURSING HOME DISTRICT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMMY J MURDOCK LPN (ADMINISTRATOR)
(660) 645-2243
Entity
Organization
Contact information
Practice address
12498 SE HIGHWAY 116, BRAYMER, MO 64624-9107
(660) 645-2243
(660) 645-2719
Mailing address
12498 SE HIGHWAY 116, BRAYMER, MO 64624-9107
(660) 645-2243
(660) 645-2719
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
038984
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101487106
—
MO
Enumeration date
10/06/2005
Last updated
11/21/2011
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