Provider Demographics
NPI:1518620228
Name:GOLDEN HEART HOME CARE LLC
Entity Type:Organization
Organization Name:GOLDEN HEART HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:314-363-4010
Mailing Address - Street 1:16747 STANFORD PLACE DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-3214
Mailing Address - Country:US
Mailing Address - Phone:314-363-4010
Mailing Address - Fax:
Practice Address - Street 1:16747 STANFORD PLACE DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-3214
Practice Address - Country:US
Practice Address - Phone:314-363-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27019284OtherMOID