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General NPI Number Information
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NPI Number | 1447168794
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Entity Type | Organization
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Legal Business Name | GOLDEN AGE AT RODEO DRIVE
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Dates
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Enumeration Date | 08/28/2026
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Last Update Date | 08/28/2026
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Provider Practice Location Address
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Address Line | 2891 RODEO DR
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City | KISSIMMEE
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State | FL
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Zip | 34746-3236
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Country | US
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Telephone | 407-495-8446
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Fax | 407-201-8960
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Provider Business Mailing Address
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Address Line | 2891 RODEO DR
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City | KISSIMMEE
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State | FL
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Zip | 34746-3236
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Country | US
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Telephone | 407-495-8446
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Fax | 407-201-8960
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MARIE SIMPLY HEALTHCARE LO LAWRENCE
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Credential | LAWRENCE
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Telephone | 407-495-8446
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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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