MEDICARE: GOLDEN BRANCH INC

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1780134064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN BRANCH INC

Provider Business Mailing Address
First Line	:	18540 NW 22ND CT
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18540 NW 22ND CT
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3213
Country	:	US
Telephone Number	:	786-310-5742
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	JULINE ALLEN
Credential	:
Telephone Number	:	786-310-5742

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

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Directions to “GOLDEN BRANCH INC ” Practice Location

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