Healthcare Provider Details

I. General information

NPI: 1710517362
Provider Name (Legal Business Name): THE GOLDEN YEARS ADC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10659 W ATLANTIC BLVD
CORAL SPRINGS FL
33071-5669
US

IV. Provider business mailing address

10659 W ATLANTIC BLVD
CORAL SPRINGS FL
33071-5669
US

V. Phone/Fax

Practice location:
  • Phone: 561-480-7557
  • Fax:
Mailing address:
  • Phone: 561-480-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO MARRERO
Title or Position: ADMIN
Credential:
Phone: 561-480-7557