Golden Age, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

040983 Issued in IA

Legal business name

GOLDEN AGE, INC.

Doing business as

Golden Age Skilled Nursing & Rehab

Practice address

1915 S 18TH St
Centerville, IA 52544-3102

Phone

(641) 856-2761

Fax

(641) 856-2762

NPI assigned

Nov 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stan L Birchem

Title

Owner

Phone

(641) 856-2757

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Golden Age Skilled Nursing & Rehab Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259884800000",
    "number": "1356428718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 S 18TH ST",
            "city": "CENTERVILLE",
            "state": "IA",
            "postal_code": "525443102",
            "telephone_number": "641-856-2761",
            "fax_number": "641-856-2762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 S 18TH ST",
            "city": "CENTERVILLE",
            "state": "IA",
            "postal_code": "525443102",
            "telephone_number": "641-856-2761",
            "fax_number": "641-856-2762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN AGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2009-12-04",
        "status": "A",
        "authorized_official_last_name": "BIRCHEM",
        "authorized_official_first_name": "STAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "641-856-2757"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "040983",
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "IA",
            "license": "040983",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "65257",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0168922",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0809376",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Golden Age Skilled Nursing & Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Centerville, IA
• Providers in Centerville, IA by specialty
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.