Provider Demographics
NPI:1164560116
Name:GOLDEN AGE HOME CARE OF BROWARD LLC
Entity Type:Organization
Organization Name:GOLDEN AGE HOME CARE OF BROWARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-824-0355
Mailing Address - Street 1:3350 SW 148TH AVE,
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3237
Mailing Address - Country:US
Mailing Address - Phone:954-874-1701
Mailing Address - Fax:954-874-1704
Practice Address - Street 1:3350 SW 148TH AVE,
Practice Address - Street 2:SUITE 110
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3237
Practice Address - Country:US
Practice Address - Phone:954-874-1701
Practice Address - Fax:954-874-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHH19964839251E00000X
FL299992166251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health