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General NPI Number Information
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NPI Number | 1124566393
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Entity Type | Organization
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Legal Business Name | 220 GOLDEN LLC
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 220 9TH ST
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City | PORT ST JOE
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State | FL
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Zip | 32456-1924
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Country | US
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Telephone | 954-367-4597
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Fax | 954-367-4564
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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 | 954-367-4563
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MARLINE C DUROSEAU
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Credential |
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Telephone | 954-367-4597
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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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