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General NPI Number Information
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NPI Number | 1255772398
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Entity Type | Organization
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Legal Business Name | GOLDEN AGE ASSISTED LIVING FACILITY II, LLC
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 14935 SW 297TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33033-3701
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Country | US
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Telephone | 786-404-3172
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Fax | 786-404-3172
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Provider Business Mailing Address
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Address Line | 14935 SW 297TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33033-3701
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Country | US
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Telephone | 786-404-3172
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Fax | 786-404-3172
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ZAIDA LIS TORRES
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Credential |
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Telephone | 786-447-6491
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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 | AL10592
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License Number State | FL
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