Provider Demographics
NPI:1487229647
Name:GOLDEN AGE FOREVER CORP
Entity Type:Organization
Organization Name:GOLDEN AGE FOREVER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:PONS LEDESMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-556-9296
Mailing Address - Street 1:1275 W 47TH PL STE 409
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3451
Mailing Address - Country:US
Mailing Address - Phone:786-556-9296
Mailing Address - Fax:
Practice Address - Street 1:1275 W 47TH PL STE 409
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3451
Practice Address - Country:US
Practice Address - Phone:786-556-9296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management