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General NPI Number Information
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NPI Number | 1336312008
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Entity Type | Organization
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Legal Business Name | GOLDEN ABBEY ENTERPRISES, II, INC
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 1321 HERBERT ST
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City | PORT ORANGE
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State | FL
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Zip | 32129-4135
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Country | US
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Telephone | 386-763-9800
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Fax | 386-763-0828
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Provider Business Mailing Address
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Address Line | 1321 HERBERT ST
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City | PORT ORANGE
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State | FL
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Zip | 32129-4135
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Country | US
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Telephone | 386-763-9800
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Fax | 386-763-0828
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MANUEL P SALDON
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Credential |
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Telephone | 386-763-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | AL9902
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License Number State | FL
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