Provider Demographics
NPI:1760966725
Name:HEART OF GOLD SENIOR SERVICES, LLC
Entity Type:Organization
Organization Name:HEART OF GOLD SENIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-595-8927
Mailing Address - Street 1:1508 LAKE ALFRED RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ALFRED
Mailing Address - State:FL
Mailing Address - Zip Code:33850-3166
Mailing Address - Country:US
Mailing Address - Phone:863-595-8927
Mailing Address - Fax:863-877-2974
Practice Address - Street 1:1508 LAKE ALFRED RD
Practice Address - Street 2:
Practice Address - City:LAKE ALFRED
Practice Address - State:FL
Practice Address - Zip Code:33850-3166
Practice Address - Country:US
Practice Address - Phone:863-595-8927
Practice Address - Fax:863-877-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid