Golden Age Senior Care Hospital, LLC

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

License

540 Issued in LA

Legal business name

GOLDEN AGE SENIOR CARE HOSPITAL, LLC

Practice address

4310 S Grand St
Monroe, LA 71202-6322

Phone

(318) 651-0920

Fax

(318) 651-0921

NPI assigned

Jul 5, 2006

Organization subpart

No

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

Authorized official

Name

Walter O Bigby

Title

Administrator

Phone

(318) 651-0920

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Hospital certification: CCN 194070

Legal name

GOLDEN AGE SENIOR CARE HOSPITAL

Certification status

Terminated Involuntary: failure to meet health/safety requirements, Feb 9, 2011

Provider type (POS)

Hospital – Psychiatric

Participating since

Sep 29, 2004

Last certification

Sep 1, 2010

Beds

12

Ownership / control type

Private (for profit)

Facility address

4310 South Grand Street
Monroe, LA 71202

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236729600000",
    "number": "1518998020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712210006",
            "telephone_number": "318-556-8000",
            "fax_number": "318-556-1197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 S GRAND ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712026322",
            "telephone_number": "318-651-0920",
            "fax_number": "318-651-0921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN AGE SENIOR CARE HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2009-03-11",
        "status": "A",
        "authorized_official_last_name": "BIGBY",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-651-0920"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "LA",
            "license": "540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1709531",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF LOUISIANA",
            "identifier": "190061362Z",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Go Ride Monroe
• Kara Katherine Goddard, M.D.
• Charles Godfrey
• Andria Goins
• Cedric Goins
• Marilyn F Goldman
• Robert Bruce Golson, M.D.
• Ashley Stewart Gomez, D.O.
• Meagan Gonzalez, FNP
• Good 2 Be Physical Therapy, LLC (Scoliosis Physical Therapy)

• Psychiatric Hospital in Monroe, LA
• Providers in Monroe, LA by specialty
• Psychiatric Hospital in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.