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General NPI Number Information
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NPI Number | 1285140657
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Entity Type | Organization
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Legal Business Name | GOLDEN AGE HOUSE ASSISTED LIVING LLC
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 12/21/2017
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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 | 386-237-2026
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Fax | 386-237-2026
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Provider Business Mailing Address
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Address Line | 31 PORT ECHO LN
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City | PALM COAST
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State | FL
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Zip | 32164-6733
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Country | US
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Telephone | 386-237-2026
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. GALYNA LONC
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Credential |
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Telephone | 386-237-2026
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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 |
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License Number State |
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