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General NPI Number Information
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NPI Number | 1104255488
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Entity Type | Organization
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Legal Business Name | 206 GOLDEN LLC
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 12/04/2013
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Provider Practice Location Address
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Address Line | 206 W ORANGE ST
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City | DAVENPORT
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State | FL
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Zip | 33837-3118
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Country | US
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Telephone | 863-422-4961
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Fax | 863-422-1707
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Provider Business Mailing Address
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Address Line | 6511 NOVA DR STE 168
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City | DAVIE
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State | FL
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Zip | 33317-7401
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Country | US
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Telephone | 813-965-8090
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Fax | 954-337-0586
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Authorized Official
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Title or Position | CFO
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Name | MARGARET FERNANDEZ
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Credential |
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Telephone | 954-241-0345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | FL
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