Healthcare Provider Details

I. General information

NPI: 1942472006
Provider Name (Legal Business Name): GOLDEN ABBEY ENTERPRISES II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2008
Last Update Date: 03/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 HERBERT ST
PORT ORANGE FL
32129-4135
US

IV. Provider business mailing address

1321 HERBERT ST
PORT ORANGE FL
32129-4135
US

V. Phone/Fax

Practice location:
  • Phone: 386-763-9800
  • Fax: 386-763-0828
Mailing address:
  • Phone: 386-763-9800
  • Fax: 386-763-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MANUEL P SALDON
Title or Position: ADMINISTRATOR
Credential:
Phone: 386-763-9800