Healthcare Provider Details

I. General information

NPI: 1801347281
Provider Name (Legal Business Name): GOLDEN BRANCH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18540 NW 22ND CT
MIAMI GARDENS FL
33056-3213
US

IV. Provider business mailing address

18540 NW 22ND COURT
MIAMI FL
33056
US

V. Phone/Fax

Practice location:
  • Phone: 305-763-4840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JULINE ALLEN
Title or Position: ADMIN
Credential:
Phone: 305-763-4840