Healthcare Provider Details

I. General information

NPI: 1811720865
Provider Name (Legal Business Name): GOLDEN AGE SENIORS OF LAUDERDALE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 SW 68TH TER
NORTH LAUDERDALE FL
33068-4338
US

IV. Provider business mailing address

PO BOX 16472
PLANTATION FL
33318-6472
US

V. Phone/Fax

Practice location:
  • Phone: 305-778-3157
  • Fax: 888-538-2226
Mailing address:
  • Phone: 305-778-3157
  • Fax: 888-538-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. MARJORIE GILLESPIE
Title or Position: PRESIDENT
Credential: ARNP
Phone: 305-778-3157