Provider Demographics
NPI:1083055123
Name:GOLDEN AGE ASSISTED LIVING FACILITY III, LLC
Entity Type:Organization
Organization Name:GOLDEN AGE ASSISTED LIVING FACILITY III, 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 1:2793 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5439
Mailing Address - Country:US
Mailing Address - Phone:305-362-5264
Mailing Address - Fax:305-362-5264
Practice Address - Street 1:2793 W 72ND ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5439
Practice Address - Country:US
Practice Address - Phone:305-362-5264
Practice Address - Fax:305-362-5264
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
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility