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General NPI Number Information
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NPI Number | 1164560116
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Entity Type | Organization
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Legal Business Name | GOLDEN AGE HOME CARE OF BROWARD LLC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 3350 SW 148TH AVE, SUITE 110
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City | MIRAMAR
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State | FL
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Zip | 33027-3237
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Country | US
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Telephone | 954-874-1701
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Fax | 954-874-1704
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Provider Business Mailing Address
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Address Line | 3350 SW 148TH AVE, SUITE 110
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City | MIRAMAR
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State | FL
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Zip | 33027-3237
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Country | US
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Telephone | 954-874-1701
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Fax | 954-874-1704
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BARBARA BAEZ
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Credential |
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Telephone | 305-824-0355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HH19964839
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299992166
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License Number State | FL
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