MEDICARE: GOLDEN ERA LLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1235080433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN ERA LLC

Provider Business Mailing Address
First Line	:	21985 RHODODENDRON CIR
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-1481
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21985 RHODODENDRON CIR
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-1481
Country	:	US
Telephone Number	:	734-624-9531
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAURA ROSE
Credential	:
Telephone Number	:	734-624-9531

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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Directions to “GOLDEN ERA LLC ” Practice Location

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