Provider Demographics
NPI:1932799541
Name:GOLDEN MENTAL LLC
Entity Type:Organization
Organization Name:GOLDEN MENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YANIRYS
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHADO MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-970-6206
Mailing Address - Street 1:777 NW 72ND AVE STE 1112AND
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3009
Mailing Address - Country:US
Mailing Address - Phone:786-401-6286
Mailing Address - Fax:
Practice Address - Street 1:777 NW 72ND AVE STE 1112AND
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3009
Practice Address - Country:US
Practice Address - Phone:786-401-6286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)