Provider Demographics
NPI:1437673456
Name:13455 GOLDEN LLC
Entity Type:Organization
Organization Name:13455 GOLDEN LLC
Other - Org Name:CROSSWINDS HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARLINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUROSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-367-4563
Mailing Address - Street 1:6511 NOVA DR STE 168
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7401
Mailing Address - Country:US
Mailing Address - Phone:813-956-8090
Mailing Address - Fax:
Practice Address - Street 1:13455 WEST HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32331
Practice Address - Country:US
Practice Address - Phone:954-367-4597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPPLYINGMedicaid