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NPI Code Detail

MEDICARE: 1755 GOLDEN LLC

MEDICARE: 1755 GOLDEN 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1871946194
Entity Type Code : Organization
Provider Name (Legal Business Name) : 1755 GOLDEN LLC
Provider Business Mailing Address
First Line : 6511 NOVA DR STE 168
Second Line :
City : DAVIE
State : FL
Zip : 33317-7401
Country : US
Telephone Number : 813-956-8090
Fax Number :
Provider Business Practice Location Address
First Line : 1755 18TH ST
Second Line :
City : SARASOTA
State : FL
Zip : 34234-8657
Country : US
Telephone Number : 941-955-4915
Fax Number :
Authorized Official
Title or Position : CFO
Name : MARLINE C DUROSEAU
Credential :
Telephone Number : 954-367-4597
Provider Enumeration Date : 07/21/2016
Last Update Date : 08/09/2016

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Directions to “1755 GOLDEN LLC ” Practice Location

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