MEDICARE: BLESSED GOLDEN YEARS, 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	310400000X	Assisted Living Facility	13198	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

General Provider Information

NPI Number	:	1568948065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLESSED GOLDEN YEARS, LLC

Provider Business Mailing Address
First Line	:	1230 SW 94TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-3046
Country	:	US
Telephone Number	:	305-763-4259
Fax Number	:	786-431-1702

Provider Business Practice Location Address
First Line	:	1230 SW 94TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-3046
Country	:	US
Telephone Number	:	305-763-4259
Fax Number	:	786-431-1702

Authorized Official
Title or Position	:	OWNER/ADMIN.
Name	:	YULIET TOLEDO
Credential	:
Telephone Number	:	305-763-4259

Provider Enumeration Date	:	07/17/2018
Last Update Date	:	05/13/2019

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Directions to “BLESSED GOLDEN YEARS, LLC ” Practice Location

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