Provider Demographics
NPI:1609588276
Name:HEART OF GOLD AGENCY
Entity Type:Organization
Organization Name:HEART OF GOLD AGENCY
Other - Org Name:HEART OF GOLD AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-461-9200
Mailing Address - Street 1:801 W STATE ROAD 436 STE 2151
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3056
Mailing Address - Country:US
Mailing Address - Phone:844-461-9200
Mailing Address - Fax:877-388-0348
Practice Address - Street 1:801 W STATE ROAD 436 STE 2151
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3056
Practice Address - Country:US
Practice Address - Phone:844-461-9200
Practice Address - Fax:877-388-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-15
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116581400Medicaid