Healthcare Provider Details

I. General information

NPI: 1326959941
Provider Name (Legal Business Name): GOLDEN GULLY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 10TH AVE N
SAINT PETERSBURG FL
33713-6528
US

IV. Provider business mailing address

3636 10TH AVE N
SAINT PETERSBURG FL
33713-6528
US

V. Phone/Fax

Practice location:
  • Phone: 727-324-6915
  • Fax: 737-577-8969
Mailing address:
  • Phone: 727-324-6915
  • Fax: 737-577-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: SECRETARY
Credential:
Phone: 949-540-1249