Provider Demographics
NPI:1841619962
Name:GOLDEN RETREAT-2 ASSISTED LIVING FACILITY LLC
Entity Type:Organization
Organization Name:GOLDEN RETREAT-2 ASSISTED LIVING FACILITY LLC
Other - Org Name:GOLDEN RETREAT-2 ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:AUGUSTUS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, BBA
Authorized Official - Phone:561-234-7723
Mailing Address - Street 1:9465 LONGMEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-3119
Mailing Address - Country:US
Mailing Address - Phone:561-234-7723
Mailing Address - Fax:
Practice Address - Street 1:9465 LONGMEADOW CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-3119
Practice Address - Country:US
Practice Address - Phone:561-234-7723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12488310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility