Provider Demographics
NPI:1295012870
Name:SR GOLDEN HEART PROVIDER CARE AND TRANSPORTATIPON SERVICES, LLC
Entity Type:Organization
Organization Name:SR GOLDEN HEART PROVIDER CARE AND TRANSPORTATIPON SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:GASSIMU
Authorized Official - Last Name:SAFFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-784-2480
Mailing Address - Street 1:7100 REGENCY SQUARE BLVD
Mailing Address - Street 2:SUITE 203-5
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3202
Mailing Address - Country:US
Mailing Address - Phone:713-784-2480
Mailing Address - Fax:713-784-2860
Practice Address - Street 1:7100 REGENCY SQUARE BLVD
Practice Address - Street 2:SUITE 203-5
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3202
Practice Address - Country:US
Practice Address - Phone:713-784-2480
Practice Address - Fax:713-784-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty