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General NPI Number Information
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NPI Number | 1013219419
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Entity Type | Organization
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Legal Business Name | GOLDEN HOUSE ASSISTED LIVING INC.
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 102 RAE DR
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City | PALM COAST
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State | FL
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Zip | 32164-6894
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Country | US
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Telephone | 386-437-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 521 DEGAS AVE
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City | PONTE VEDRA
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State | FL
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Zip | 32081-5011
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Country | US
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Telephone | 386-437-1122
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GABRIELA PELLOSMAA
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Credential |
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Telephone | 386-437-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL11494
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License Number State | FL
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