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General NPI Number Information
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NPI Number | 1356711741
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Entity Type | Organization
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Legal Business Name | GOLDEN RETREAT AT COCONUT CREEK
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 5101 NW 47TH AVE
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4942
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Country | US
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Telephone | 954-428-0241
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Fax | 954-573-7164
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Provider Business Mailing Address
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Address Line | 5101 NW 47TH AVE
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4942
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Country | US
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Telephone | 954-428-0241
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Fax | 954-573-7164
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DIONNE TULLOCH
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Credential |
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Telephone | 954-428-0241
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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 | 6905847
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License Number State | FL
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