Healthcare Provider Details

I. General information

NPI: 1386178598
Provider Name (Legal Business Name): GOLDEN HEALTH OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 NE MARION ST
MADISON FL
32340-2511
US

IV. Provider business mailing address

100 SALEM CT
TALLAHASSEE FL
32301-2810
US

V. Phone/Fax

Practice location:
  • Phone: 314-503-7704
  • Fax:
Mailing address:
  • Phone: 314-503-7704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BOAFO YAW MANU
Title or Position: OWNER
Credential:
Phone: 314-503-7704