Provider Demographics
NPI:1922581925
Name:5888 GOLDEN LLC
Entity Type:Organization
Organization Name:5888 GOLDEN LLC
Other - Org Name:
Other - Org Type:
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:
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:954-367-4564
Practice Address - Street 1:5888 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-1927
Practice Address - Country:US
Practice Address - Phone:954-367-4597
Practice Address - Fax:954-367-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid