Provider Demographics
NPI:1952055642
Name:GOLDENTENDERHEART LLC
Entity Type:Organization
Organization Name:GOLDENTENDERHEART LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EPHARUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHOYA
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:781-353-8993
Mailing Address - Street 1:11 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3134
Mailing Address - Country:US
Mailing Address - Phone:978-783-3182
Mailing Address - Fax:978-783-3182
Practice Address - Street 1:11 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3134
Practice Address - Country:US
Practice Address - Phone:978-783-3182
Practice Address - Fax:978-783-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A