Provider Demographics
NPI:1790234409
Name:PINE ACRES GOLDEN AGE CENTRE INC.
Entity Type:Organization
Organization Name:PINE ACRES GOLDEN AGE CENTRE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-298-4973
Mailing Address - Street 1:5030 CUB LAKE DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1942
Mailing Address - Country:US
Mailing Address - Phone:407-298-4973
Mailing Address - Fax:407-270-7879
Practice Address - Street 1:5030 CUB LAKE DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-1942
Practice Address - Country:US
Practice Address - Phone:407-298-4973
Practice Address - Fax:407-270-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL#6106310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility