Healthcare Provider Details

I. General information

NPI: 1396269197
Provider Name (Legal Business Name): CL GOLDEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 N JEFFERSON HWY
MONTICELLO FL
32344-5536
US

IV. Provider business mailing address

6511 NOVA DR STE 168
DAVIE FL
33317-7401
US

V. Phone/Fax

Practice location:
  • Phone: 850-399-0464
  • Fax: 850-399-0464
Mailing address:
  • Phone: 954-367-4597
  • Fax: 954-367-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MARLINE C DUROSEAU
Title or Position: CFO
Credential:
Phone: 954-367-4563