MEDICARE: GOLDEN CARRIAGE RETIREMENT HOME

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

General Provider Information

NPI Number	:	1396103966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN CARRIAGE RETIREMENT HOME

Provider Business Mailing Address
First Line	:	926 MELLER WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-3801
Country	:	US
Telephone Number	:	321-356-9636
Fax Number	:	407-679-5325

Provider Business Practice Location Address
First Line	:	926 MELLER WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-3801
Country	:	US
Telephone Number	:	321-356-9636
Fax Number	:	407-679-5325

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MARIE PUN
Credential	:	RN
Telephone Number	:	321-356-9636

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	02/10/2016

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Directions to “GOLDEN CARRIAGE RETIREMENT HOME ” Practice Location

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