Healthcare Provider Details

I. General information

NPI: 1083971519
Provider Name (Legal Business Name): GOLDEN AGE DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2012
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30370 OLD DIXIE HWY
HOMESTEAD FL
33033-3215
US

IV. Provider business mailing address

30370 OLD DIXIE HWY
HOMESTEAD FL
33033-3215
US

V. Phone/Fax

Practice location:
  • Phone: 786-252-7632
  • Fax:
Mailing address:
  • Phone: 786-252-7632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MISS LEIZA RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 786-252-7632