Provider Demographics
NPI:1417381757
Name:GOLDEN DIVERSIFIED SERVICE INC
Entity Type:Organization
Organization Name:GOLDEN DIVERSIFIED SERVICE INC
Other - Org Name:GOLDEN SANDS RETIREMENT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SWABY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KERR ROLLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-524-6054
Mailing Address - Street 1:809 NE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3035
Mailing Address - Country:US
Mailing Address - Phone:954-524-6054
Mailing Address - Fax:954-525-6868
Practice Address - Street 1:809 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3035
Practice Address - Country:US
Practice Address - Phone:954-524-6054
Practice Address - Fax:954-525-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5433310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility