Healthcare Provider Details

I. General information

NPI: 1841539897
Provider Name (Legal Business Name): GOLDEN MIRACLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 07/21/2023
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14601 SW 29TH ST STE 110
MIRAMAR FL
33027-4715
US

IV. Provider business mailing address

14601 SW 29TH ST STE 110
MIRAMAR FL
33027-4715
US

V. Phone/Fax

Practice location:
  • Phone: 954-862-2236
  • Fax: 954-944-0822
Mailing address:
  • Phone: 954-862-2236
  • Fax: 954-944-0822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299994039
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: MR. BRENO L CARDOSO
Title or Position: PRESIDENT
Credential:
Phone: 954-862-2236