MEDICARE: GOLDEN SUCCESS

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	251C00000X	Developmentally Disabled Services Day Training Agency	688758998	FL
2	251C00000X	Developmentally Disabled Services Day Training Agency	688758996	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497046940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN SUCCESS

Provider Business Mailing Address
First Line	:	4719 NE 32ND LN
Second Line	:
City	:	SILVER SPRINGS
State	:	FL
Zip	:	34488-8716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4719 NE 32ND LN
Second Line	:
City	:	SILVER SPRINGS
State	:	FL
Zip	:	34488-8716
Country	:	US
Telephone Number	:	352-342-0037
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EBONY DAVIS
Credential	:
Telephone Number	:	352-342-0037

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	05/02/2011

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Directions to “GOLDEN SUCCESS ” Practice Location

Language	Start Address	Practice Location

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