Provider Demographics
NPI:1013359819
Name:GOLDEN ABBEY ENTERPRISES, INC
Entity Type:Organization
Organization Name:GOLDEN ABBEY ENTERPRISES, INC
Other - Org Name:GOLDEN ABBEY ORMOND BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:CABITAC
Authorized Official - Last Name:LAVARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:386-236-1829
Mailing Address - Street 1:1410 HAND AVE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8193
Mailing Address - Country:US
Mailing Address - Phone:386-236-1829
Mailing Address - Fax:386-236-1833
Practice Address - Street 1:1410 HAND AVE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8193
Practice Address - Country:US
Practice Address - Phone:386-236-1829
Practice Address - Fax:386-236-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11475310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility