Provider Demographics
NPI:1801395322
Name:GOLDEN LIFE MENTAL HEALTH CORP
Entity Type:Organization
Organization Name:GOLDEN LIFE MENTAL HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLINA PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:305-600-8044
Mailing Address - Street 1:9480 NW 41ST ST APT 618
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4960
Mailing Address - Country:US
Mailing Address - Phone:305-600-8044
Mailing Address - Fax:305-489-8377
Practice Address - Street 1:9480 NW 41ST ST APT 618
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4960
Practice Address - Country:US
Practice Address - Phone:305-600-8044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-10
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023906000Medicaid