=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841539897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN MIRACLE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2013
-----------------------------------------------------
Last Update Date | 07/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14601 SW 29TH ST STE 110
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027-4715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-862-2236
-----------------------------------------------------
Fax | 954-944-0822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14601 SW 29TH ST STE 110
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027-4715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-862-2236
-----------------------------------------------------
Fax | 954-944-0822
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. BRENO L CARDOSO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-862-2236
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747A0650X
-----------------------------------------------------
Taxonomy Name | Attendant Care Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299994039
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------