MEDICARE: GOLD COAST LOVING CAR 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	310400000X	Assisted Living Facility	AL11493	FL

General Provider Information

NPI Number	:	1225373186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD COAST LOVING CAR INC.

Provider Business Mailing Address
First Line	:	5517 HAYES ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-4632
Country	:	US
Telephone Number	:	954-534-9401
Fax Number	:	954-639-7796

Provider Business Practice Location Address
First Line	:	5517 HAYES ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-4632
Country	:	US
Telephone Number	:	954-534-9401
Fax Number	:	954-639-7796

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	GOLDIE PIERRE
Credential	:
Telephone Number	:	954-534-9401

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	12/04/2012

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