Provider Demographics
NPI:1033957063
Name:GOLDEN AGE ADULT DAY CARE CORP
Entity type:Organization
Organization Name:GOLDEN AGE ADULT DAY CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:C
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-603-9705
Mailing Address - Street 1:8950 SW 152ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2066
Mailing Address - Country:US
Mailing Address - Phone:786-603-9705
Mailing Address - Fax:
Practice Address - Street 1:8950 SW 152ND ST STE 101
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-2066
Practice Address - Country:US
Practice Address - Phone:786-603-9705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9609OtherAHCA