Provider Demographics
NPI:1184200206
Name:THE GOLDEN AGE COMMUNITY CENTER LLC
Entity Type:Organization
Organization Name:THE GOLDEN AGE COMMUNITY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLINYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PILETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-849-5251
Mailing Address - Street 1:2353-57 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145
Mailing Address - Country:US
Mailing Address - Phone:305-849-5251
Mailing Address - Fax:
Practice Address - Street 1:2353-57 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145
Practice Address - Country:US
Practice Address - Phone:305-849-5251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health