Provider Demographics
NPI:1497649032
Name:THE GOLDEN AGE MENTAL HEALTH LLC
Entity type:Organization
Organization Name:THE GOLDEN AGE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CEPERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-203-1248
Mailing Address - Street 1:1490 NE PINE ISLAND RD BLDG 6
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2135
Mailing Address - Country:US
Mailing Address - Phone:239-203-1248
Mailing Address - Fax:239-510-2292
Practice Address - Street 1:1490 NE PINE ISLAND RD BLDG 6
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2135
Practice Address - Country:US
Practice Address - Phone:239-203-1248
Practice Address - Fax:239-510-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)