Provider Demographics
NPI:1578275913
Name:GOLDEN AGE RESIDENCES LLC
Entity Type:Organization
Organization Name:GOLDEN AGE RESIDENCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMAHIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-583-3321
Mailing Address - Street 1:1110 SW 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4527
Mailing Address - Country:US
Mailing Address - Phone:954-583-3321
Mailing Address - Fax:954-583-8240
Practice Address - Street 1:1110 SW 40TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4527
Practice Address - Country:US
Practice Address - Phone:954-583-3321
Practice Address - Fax:954-583-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness