Provider Demographics
NPI:1013589324
Name:GOLDEN MIRACLE, INC
Entity Type:Organization
Organization Name:GOLDEN MIRACLE, INC
Other - Org Name:GOLDEN MIRACLE, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-862-2236
Mailing Address - Street 1:14601 SW 29TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4715
Mailing Address - Country:US
Mailing Address - Phone:954-862-2236
Mailing Address - Fax:954-944-0822
Practice Address - Street 1:7900 OAK LN STE 401
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-6001
Practice Address - Country:US
Practice Address - Phone:954-862-2236
Practice Address - Fax:954-944-0822
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN MIRACLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-15
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002023802Medicaid