Provider Demographics
NPI:1952906000
Name:GOLDEN SENIOR COMMUNITY THERAPY CORP
Entity type:Organization
Organization Name:GOLDEN SENIOR COMMUNITY THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YANISLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDIVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-542-9937
Mailing Address - Street 1:3382 NW 151ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2410
Mailing Address - Country:US
Mailing Address - Phone:786-542-9937
Mailing Address - Fax:786-796-1626
Practice Address - Street 1:3382 NW 151ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33054-2410
Practice Address - Country:US
Practice Address - Phone:786-542-9937
Practice Address - Fax:786-796-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108875300Medicaid