Provider Demographics
NPI:1396023784
Name:SR GOLDEN HEART PROVIDER CARE AND TRANSPORTATION SERVICES, LLC
Entity Type:Organization
Organization Name:SR GOLDEN HEART PROVIDER CARE AND TRANSPORTATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEVAO
Authorized Official - Middle Name:FAYIA
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:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities