Provider Demographics
NPI:1396379731
Name:GOLDEN CARRIAGE RETIREMENT HOME I INC
Entity Type:Organization
Organization Name:GOLDEN CARRIAGE RETIREMENT HOME I INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-662-4081
Mailing Address - Street 1:926 MELLER WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3801
Mailing Address - Country:US
Mailing Address - Phone:954-662-4081
Mailing Address - Fax:
Practice Address - Street 1:926 MELLER WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3801
Practice Address - Country:US
Practice Address - Phone:954-662-4081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGOLDENCARRIAGESHAWMedicaid