MEDICARE: GODEN ROSE TOUCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	6906874	FL

General Provider Information

NPI Number	:	1134673775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GODEN ROSE TOUCH

Provider Business Mailing Address
First Line	:	4561 NW 10TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3869
Country	:	US
Telephone Number	:	754-206-4574
Fax Number	:

Provider Business Practice Location Address
First Line	:	4561 NW 10TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3869
Country	:	US
Telephone Number	:	754-206-4574
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROSANA THEOPHIN
Credential	:
Telephone Number	:	754-206-4574

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	08/11/2016

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Directions to “GODEN ROSE TOUCH ” Practice Location

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