Provider Demographics
NPI:1265867576
Name:GOLDENAGE SANCTUARY
Entity Type:Organization
Organization Name:GOLDENAGE SANCTUARY
Other - Org Name:GRACIOUS LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:BINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-680-1554
Mailing Address - Street 1:5600 SW 185TH WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1401
Mailing Address - Country:US
Mailing Address - Phone:954-680-1554
Mailing Address - Fax:954-533-4098
Practice Address - Street 1:5600 SW 185TH WAY
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33332-1401
Practice Address - Country:US
Practice Address - Phone:954-680-1554
Practice Address - Fax:954-533-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9879310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility