Provider Demographics
NPI:1336430990
Name:GOLDEN HAVEN LLC
Entity type:Organization
Organization Name:GOLDEN HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:V
Authorized Official - Last Name:TOMINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-682-5806
Mailing Address - Street 1:110 ZACALO WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-9536
Mailing Address - Country:US
Mailing Address - Phone:321-682-5806
Mailing Address - Fax:321-682-5806
Practice Address - Street 1:110 ZACALO WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-9536
Practice Address - Country:US
Practice Address - Phone:321-682-5806
Practice Address - Fax:321-682-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11854310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility