Healthcare Provider Details

I. General information

NPI: 1033957063
Provider Name (Legal Business Name): GOLDEN AGE ADULT DAY CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 SW 152ND ST STE 101
PALMETTO BAY FL
33157-2066
US

IV. Provider business mailing address

8950 SW 152ND ST STE 101
PALMETTO BAY FL
33157-2066
US

V. Phone/Fax

Practice location:
  • Phone: 786-603-9705
  • Fax:
Mailing address:
  • Phone: 786-603-9705
  • Fax:

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: ROBERTO C RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 786-603-9705