Provider Demographics
NPI:1235645797
Name:THE GOLDEN YEARS ACTIVITY CENTER & REHABILITATION
Entity Type:Organization
Organization Name:THE GOLDEN YEARS ACTIVITY CENTER & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATO / CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:561-480-7557
Mailing Address - Street 1:4996 10TH AVE N STE 5
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2280
Mailing Address - Country:US
Mailing Address - Phone:561-480-7557
Mailing Address - Fax:
Practice Address - Street 1:4996 10TH AVE N STE 5
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2280
Practice Address - Country:US
Practice Address - Phone:561-480-7557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care