Provider Demographics
NPI:1750629366
Name:GOLDEN AGE ASSISTED LIVING FACILITY, CORP
Entity Type:Organization
Organization Name:GOLDEN AGE ASSISTED LIVING FACILITY, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-315-3025
Mailing Address - Street 1:5970 NW 3 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4765
Mailing Address - Country:US
Mailing Address - Phone:786-315-3025
Mailing Address - Fax:
Practice Address - Street 1:5970 NW 3 STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4765
Practice Address - Country:US
Practice Address - Phone:786-315-3025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12292310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility