Healthcare Provider Details

I. General information

NPI: 1437789062
Provider Name (Legal Business Name): THE GOLDEN YEARS @ HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 W FLAGLER ST
MIAMI FL
33135-1028
US

IV. Provider business mailing address

3536 W FLAGLER ST
MIAMI FL
33135-1028
US

V. Phone/Fax

Practice location:
  • Phone: 786-262-9130
  • Fax: 786-551-8440
Mailing address:
  • Phone: 786-262-9130
  • Fax: 786-551-8440

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: LEONOR MARRERO
Title or Position: ADMIN
Credential:
Phone: 786-262-9130