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General NPI Number Information
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NPI Number | 1750642005
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Entity Type | Organization
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Legal Business Name | GOLDEN AGE SENIOR
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 9811 NW 31ST PL
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City | SUNRISE
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State | FL
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Zip | 33351-7032
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Country | US
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Telephone | 954-742-8658
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Fax |
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Provider Business Mailing Address
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Address Line | 9811 NW 31ST PL
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City | SUNRISE
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State | FL
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Zip | 33351-7032
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Country | US
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Telephone | 954-742-8658
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARJORIE MAY GILLESPIE
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Credential | AAPRN
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Telephone | 305-778-3157
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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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