Provider Demographics
NPI:1326358896
Name:GOLDEN MANOR ASSISTED LIVING FACILITY2
Entity Type:Organization
Organization Name:GOLDEN MANOR ASSISTED LIVING FACILITY2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MALGORZATA
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-926-7937
Mailing Address - Street 1:2003 FLETCHER STR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020
Mailing Address - Country:US
Mailing Address - Phone:954-926-7937
Mailing Address - Fax:
Practice Address - Street 1:1510 S 20 TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020
Practice Address - Country:US
Practice Address - Phone:954-926-7937
Practice Address - Fax:954-926-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 9100310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility