Provider Demographics
NPI:1033279252
Name:PREMIER GOLDEN HEART HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:PREMIER GOLDEN HEART HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ITATA
Authorized Official - Middle Name:
Authorized Official - Last Name:ITATA
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:940-566-4999
Mailing Address - Street 1:2412 OLD NORTH RD STE 101K
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-1524
Mailing Address - Country:US
Mailing Address - Phone:940-566-4999
Mailing Address - Fax:
Practice Address - Street 1:2412 OLD NORTH RD STE 101K
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-1524
Practice Address - Country:US
Practice Address - Phone:940-566-4999
Practice Address - Fax:940-566-4992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010291251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677962Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER