Provider Demographics
NPI:1861082612
Name:GOLDEN SUNSHINE VILLAS, LLC
Entity type:Organization
Organization Name:GOLDEN SUNSHINE VILLAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:ANDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBLYOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:332-600-5229
Mailing Address - Street 1:447 BROADWAY 2ND FL #123
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:332-600-5229
Mailing Address - Fax:
Practice Address - Street 1:447 BROADWAY 2ND FL #123
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:332-600-5229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health