Provider Demographics
NPI:1922612365
Name:GOLDEN AGE FACILITY LLC
Entity Type:Organization
Organization Name:GOLDEN AGE FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-371-3312
Mailing Address - Street 1:4120 KIRKLAND LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5326
Mailing Address - Country:US
Mailing Address - Phone:561-619-2925
Mailing Address - Fax:561-619-2925
Practice Address - Street 1:4120 KIRKLAND LN
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-5326
Practice Address - Country:US
Practice Address - Phone:561-619-2925
Practice Address - Fax:561-619-2925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility