Organization
GOLDEN AGE SENIOR CARE HOSPITAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER O BIGBY (ADMINISTRATOR)
(318) 651-0920
Entity
Organization
Contact information
Practice address
4310 S GRAND ST, MONROE, LA 71202-6322
(318) 651-0920
(318) 651-0921
Mailing address
PO BOX 6, BASTROP, LA 71221-0006
(318) 556-8000
(318) 556-1197
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
540
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1709531
—
LA
01
—
190061362Z
BCBS OF LOUISIANA
LA
Enumeration date
07/05/2006
Last updated
03/11/2009
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