NPIMap

Organization Active NPI

Golden Age Inc

  • Nursing Facility/Intermediate Care Facility
  • Greenwood, MS
National Provider Identifier
1720073448
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
46 Issued in MS
Legal business name
GOLDEN AGE INC
Practice address
2901 Highway 82 E
Greenwood, MS 38930-6072
Phone
(662) 453-6323
Fax
(662) 455-9686
NPI assigned
Sep 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Authorized official

Name
Tabatha Watkins
Title
Administrator
Phone
(662) 453-6323

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 46 MS Primary

Addresses

Primary practice location

2901 Highway 82 E
Greenwood, MS 38930-6072

Mailing address

2901 Hwy 82 E
Greenwood, MS 38930-6072
Phone (662) 453-6323

Other identifiers 1

IdentifierTypeStateIssuer
0023053MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040918000061 MS Part A Provider - Skilled Nursing Facility 0941294292 Practice locations: Greenwood, MS

Skilled nursing facility certification: CCN 255307

Legal name
GOLDEN AGE INC
Doing business as
GOLDEN AGE NURSING HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 2004
Last certification
Nov 21, 2024
Beds
95
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 28, 1954 in MS
Enrollment address
2901 Highway 82 E
Greenwood, MS 38930-2960
Nursing home name
GOLDEN AGE NURSING HOME

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Golden Age Nursing HomeCCN 255307
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jul 1, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9585.5 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Golden Age Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Christine Lymon Individual Corporate DirectorBoard Member Feb 25, 1999
Golden Age Inc Organization, Greenwood, MS Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2004 100%
Robert Hammons Individual Corporate DirectorBoard Member Feb 27, 2003
James E Warrington Individual Corporate Officer Jan 1, 2024
Adp of the SNF Aug 28, 2025
Leroy Ware Individual Corporate DirectorBoard Member Feb 27, 2003
Tabatha Watkins Individual Corporate DirectorAdministrator Dec 10, 2021
Operational/Managerial Control Aug 9, 2021
Adp of the SNF Aug 26, 2025
Gay Moss Individual Corporate Officer Mar 12, 2015
Dwight Dunn Individual Corporate DirectorBoard Member Feb 25, 2004
Ethel Whites Individual Corporate Officer Mar 1, 2018
Russell Robertson Individual Corporate Officer Mar 1, 2018
Bobbie Methvin Individual Corporate OfficerBusiness Office Manager Jan 31, 2014
Calvin Collins Individual Corporate Officer Feb 24, 2011

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Golden Age ClinicGreenwood, MS, CCN 253824 Rural health clinic 5% Or Greater Direct Ownership Interest Sep 1, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1720073448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 HWY 82 E",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389306072",
            "telephone_number": "662-453-6323",
            "fax_number": "662-455-9686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 HIGHWAY 82 E",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389306072",
            "telephone_number": "662-453-6323",
            "fax_number": "662-455-9686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN AGE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "WATKINS",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-453-6323"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "MS",
            "license": "46",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0023053",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, MS

Sources for this page

Verify at the official NPI Registry.