Healthcare Provider Details

I. General information

NPI: 1770224370
Provider Name (Legal Business Name): THE GOLDEN YEARS SENIOR ACTIVITY CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26218 US HIGHWAY 27 STE 102
LEESBURG FL
34748-1708
US

IV. Provider business mailing address

26218 US HIGHWAY 27 STE 102
LEESBURG FL
34748-1708
US

V. Phone/Fax

Practice location:
  • Phone: 561-480-7557
  • Fax:
Mailing address:
  • Phone: 352-460-1088
  • Fax: 352-608-9026

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: JUAN ANDINO
Title or Position: ADMIN
Credential:
Phone: 561-480-7557