Provider Demographics
NPI:1073945457
Name:GOLDEN HEART CAREGIVERS LLC
Entity Type:Organization
Organization Name:GOLDEN HEART CAREGIVERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBONI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-871-2600
Mailing Address - Street 1:7770 MICHIGAN RD
Mailing Address - Street 2:SUITE: D
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2375
Mailing Address - Country:US
Mailing Address - Phone:317-871-2600
Mailing Address - Fax:317-871-2714
Practice Address - Street 1:7770 MICHIGAN RD
Practice Address - Street 2:SUITE: D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2375
Practice Address - Country:US
Practice Address - Phone:317-871-2600
Practice Address - Fax:317-871-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13-013270-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201170870 AMedicaid