Provider Demographics
NPI:1871370585
Name:HEART OF GOLD GROUP HOME LLC
Entity type:Organization
Organization Name:HEART OF GOLD GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-687-0086
Mailing Address - Street 1:41261 W LUCERA LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-4645
Mailing Address - Country:US
Mailing Address - Phone:520-840-4298
Mailing Address - Fax:
Practice Address - Street 1:41261 W LUCERA LN
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-4645
Practice Address - Country:US
Practice Address - Phone:520-840-4298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health