Provider Demographics
NPI:1881366771
Name:GOLDEN AGE HOME CARE CORP
Entity type:Organization
Organization Name:GOLDEN AGE HOME CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YAMIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIVERA TEXIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-496-3123
Mailing Address - Street 1:1313 FREEPORT DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-4647
Mailing Address - Country:US
Mailing Address - Phone:407-496-3123
Mailing Address - Fax:386-742-8010
Practice Address - Street 1:1313 FREEPORT DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-4647
Practice Address - Country:US
Practice Address - Phone:407-496-3123
Practice Address - Fax:386-742-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility