MEDICARE: GOLDEN YEARS BEHAVIOR CENTER CORP

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	207Q00000X	Family Medicine Physician

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	:	1437898236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN YEARS BEHAVIOR CENTER CORP

Provider Business Mailing Address
First Line	:	12955 SW 42ND ST STE 2
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-2928
Country	:	US
Telephone Number	:	305-364-5711
Fax Number	:	305-364-5711

Provider Business Practice Location Address
First Line	:	12955 SW 42ND ST STE 2
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-2928
Country	:	US
Telephone Number	:	305-364-5711
Fax Number	:	305-364-5711

Authorized Official
Title or Position	:	VP
Name	:	GLEYS J PEREZ MARTINEZ
Credential	:
Telephone Number	:	702-690-0319

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	07/08/2022

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