Provider Demographics
NPI:1598118812
Name:190 GOLDEN LLC
Entity Type:Organization
Organization Name:190 GOLDEN LLC
Other - Org Name:CROSS GARDENS CARE 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:CFO
Authorized Official - Phone:954-367-4597
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 1:190 NE 191ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-3711
Practice Address - Country:US
Practice Address - Phone:305-651-9690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility