1972650034 NPI number — GOLDEN AGE HOME MEDICAL EQUIPMENT CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972650034 NPI number — GOLDEN AGE HOME MEDICAL EQUIPMENT CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDEN AGE HOME MEDICAL EQUIPMENT CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972650034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12159 SW 132 CT
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-255-3168
Provider Business Mailing Address Fax Number:
305-255-3169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12159 SW 132 CT
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-255-3168
Provider Business Practice Location Address Fax Number:
305-255-3169
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-255-3168

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com