Provider Demographics
NPI:1972253102
Name:GOLDEN HEART CARE
Entity Type:Organization
Organization Name:GOLDEN HEART CARE
Other - Org Name:GOLDEN HEART CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLICANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-248-1162
Mailing Address - Street 1:21620 N 19TH AVE STE A6
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2716
Mailing Address - Country:US
Mailing Address - Phone:623-606-1907
Mailing Address - Fax:
Practice Address - Street 1:4208 W HATCHER RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3249
Practice Address - Country:US
Practice Address - Phone:623-248-1162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health