Healthcare Provider Details

I. General information

NPI: 1235645797
Provider Name (Legal Business Name): THE GOLDEN YEARS ACTIVITY CENTER & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4996 10TH AVE N STE 5
GREENACRES FL
33463-2280
US

IV. Provider business mailing address

4996 10TH AVE N STE 5
GREENACRES FL
33463-2280
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 StateFL

VIII. Authorized Official

Name: ANTONIO MARRERO
Title or Position: ADMINISTRATO / CFO
Credential: EMT-P
Phone: 561-480-7557