Provider Demographics
NPI:1942691332
Name:GOLDEN AGE ASSISTED LIVING FACILITY V, LLC
Entity Type:Organization
Organization Name:GOLDEN AGE ASSISTED LIVING FACILITY V, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZAILYS
Authorized Official - Middle Name:
Authorized Official - Last Name:OBEGON PINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-312-4796
Mailing Address - Street 1:7861 NW 175TH STRREET
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3885
Mailing Address - Country:US
Mailing Address - Phone:305-400-8976
Mailing Address - Fax:786-219-4049
Practice Address - Street 1:7861 NW 175TH STREET
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3885
Practice Address - Country:US
Practice Address - Phone:305-400-8976
Practice Address - Fax:786-219-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-07
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11384310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility