Provider Demographics
NPI:1255772398
Name:GOLDEN AGE ASSISTED LIVING FACILITY II, LLC
Entity type:Organization
Organization Name:GOLDEN AGE ASSISTED LIVING FACILITY II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZAIDA
Authorized Official - Middle Name:LIS
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-447-6491
Mailing Address - Street 1:14935 SW 297TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3701
Mailing Address - Country:US
Mailing Address - Phone:786-404-3172
Mailing Address - Fax:786-404-3172
Practice Address - Street 1:14935 SW 297TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3701
Practice Address - Country:US
Practice Address - Phone:786-404-3172
Practice Address - Fax:786-404-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10592310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility