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General NPI Number Information
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NPI Number | 1841619962
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Entity Type | Organization
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Legal Business Name | GOLDEN RETREAT-2 ASSISTED LIVING FACILITY LLC
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 9465 LONGMEADOW CIR
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-3119
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Country | US
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Telephone | 561-234-7723
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Fax |
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Provider Business Mailing Address
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Address Line | 9465 LONGMEADOW CIR
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-3119
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Country | US
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Telephone | 561-234-7723
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JACQUES AUGUSTUS DAVIS
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Credential | BA, BBA
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Telephone | 561-234-7723
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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 | AL12488
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License Number State | FL
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