MEDICARE: GOLDENCARE HOME HEALTH AGENCY, INC.

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	251E00000X	Home Health Agency	299992265	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174724413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDENCARE HOME HEALTH AGENCY, INC.

Provider Business Mailing Address
First Line	:	4101 NW 4TH ST STE 211
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-2840
Country	:	US
Telephone Number	:	954-735-7332
Fax Number	:	954-485-7142

Provider Business Practice Location Address
First Line	:	4101 NW 4TH ST STE 211
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-2840
Country	:	US
Telephone Number	:	954-735-7332
Fax Number	:	954-485-7142

Authorized Official
Title or Position	:	ADMINISTRATOR/PRES.
Name	:	MRS. ELIZABETH BRACERAS CAMPO
Credential	:
Telephone Number	:	305-863-8860

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	02/25/2021

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