Provider Demographics
NPI:1093760852
Name:GOLDEN AGE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:GOLDEN AGE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-274-7065
Mailing Address - Street 1:10250 SW 56TH ST
Mailing Address - Street 2:SUITE B203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7069
Mailing Address - Country:US
Mailing Address - Phone:305-274-7065
Mailing Address - Fax:305-274-7058
Practice Address - Street 1:10250 SW 56TH ST
Practice Address - Street 2:SUITE B203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7069
Practice Address - Country:US
Practice Address - Phone:305-274-7065
Practice Address - Fax:305-274-7058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992369251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651360300Medicaid
FL299992369OtherAHCA STATE LICENSE NO.
FL108414Medicare ID - Type UnspecifiedPROVIDER NUMBER