Healthcare Provider Details

I. General information

NPI: 1144624099
Provider Name (Legal Business Name): FL GOLDEN ADULT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 RACHELS RIDGE LOOP
OCOEE FL
34761-9000
US

IV. Provider business mailing address

1686 RACHELS RIDGE LOOP
OCOEE FL
34761-9000
US

V. Phone/Fax

Practice location:
  • Phone: 407-690-9755
  • Fax:
Mailing address:
  • Phone: 407-690-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberCNA33740
License Number StateFL

VIII. Authorized Official

Name: NANCY BUISSERETH
Title or Position: OWNER
Credential: CNA
Phone: 407-690-9755