Provider Demographics
NPI:1841539897
Name:GOLDEN MIRACLE INC
Entity type:Organization
Organization Name:GOLDEN MIRACLE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENO
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARDOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-862-2236
Mailing Address - Street 1:14601 SW 29TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4715
Mailing Address - Country:US
Mailing Address - Phone:954-862-2236
Mailing Address - Fax:954-944-0822
Practice Address - Street 1:14601 SW 29TH ST STE 110
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4715
Practice Address - Country:US
Practice Address - Phone:954-862-2236
Practice Address - Fax:954-944-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747A0650X
FL299994039251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002023800Medicaid
FL692573198Medicaid
FL002023802Medicaid
FL692573196Medicaid