MEDICARE: GOLDEN MIRACLE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider
2	251E00000X	Home Health Agency	299994039	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841539897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN MIRACLE INC

Provider Business Mailing Address
First Line	:	14601 SW 29TH ST STE 110
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4715
Country	:	US
Telephone Number	:	954-862-2236
Fax Number	:	954-944-0822

Provider Business Practice Location Address
First Line	:	14601 SW 29TH ST STE 110
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4715
Country	:	US
Telephone Number	:	954-862-2236
Fax Number	:	954-944-0822

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRENO L CARDOSO
Credential	:
Telephone Number	:	954-862-2236

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	07/21/2023

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Directions to “GOLDEN MIRACLE INC ” Practice Location

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