Healthcare Provider Details

I. General information

NPI: 1205277373
Provider Name (Legal Business Name): GOLDEN YEARS SENIOR ACTIVITY CENTER CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 BAL HARBOR BLVD STE 1135
PUNTA GORDA FL
33950-6577
US

IV. Provider business mailing address

1133 BAL HARBOR BLVD STE 1135
PUNTA GORDA FL
33950-6577
US

V. Phone/Fax

Practice location:
  • Phone: 941-655-8736
  • Fax:
Mailing address:
  • Phone: 941-655-8736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9274
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number233661
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number233661
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number233661
License Number StateFL

VIII. Authorized Official

Name: CARLOS J MOREJON
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 941-655-8736