Provider Demographics
NPI:1013219419
Name:GOLDEN HOUSE ASSISTED LIVING INC.
Entity Type:Organization
Organization Name:GOLDEN HOUSE ASSISTED LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLOSMAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-437-1122
Mailing Address - Street 1:521 DEGAS AVE
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5011
Mailing Address - Country:US
Mailing Address - Phone:386-437-1122
Mailing Address - Fax:
Practice Address - Street 1:102 RAE DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6894
Practice Address - Country:US
Practice Address - Phone:386-437-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11494310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility