Healthcare Provider Details

I. General information

NPI: 1104255488
Provider Name (Legal Business Name): 206 GOLDEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W ORANGE ST
DAVENPORT FL
33837-3118
US

IV. Provider business mailing address

6511 NOVA DR STE 168
DAVIE FL
33317-7401
US

V. Phone/Fax

Practice location:
  • Phone: 863-422-4961
  • Fax: 863-422-1707
Mailing address:
  • Phone: 813-965-8090
  • Fax: 954-337-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MARGARET FERNANDEZ
Title or Position: CFO
Credential:
Phone: 954-241-0345