Organization
GOLDEN AGE NURSING HOME OF GUTHRIE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANDIE HASTINGS (SOLE MEMBER)
(405) 282-6285
Entity
Organization
Contact information
Practice address
419 E OKLAHOMA AVE, GUTHRIE, OK 73044-3316
(405) 282-0144
(405) 282-2129
Mailing address
PO BOX 1095, GUTHRIE, OK 73044-1095
(405) 282-6285
(405) 282-5731
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH4203
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200117960A
—
OK
Enumeration date
05/24/2007
Last updated
04/19/2012
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