Provider Demographics
NPI:1336810712
Name:HEART OF GOLD SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:HEART OF GOLD SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FOLARANMI
Authorized Official - Middle Name:OLUWASEGUN
Authorized Official - Last Name:OLUWALOJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-400-8253
Mailing Address - Street 1:115 SUDBROOK LN STE F
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4184
Mailing Address - Country:US
Mailing Address - Phone:346-400-8253
Mailing Address - Fax:
Practice Address - Street 1:115 SUDBROOK LN STE F
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4184
Practice Address - Country:US
Practice Address - Phone:346-400-8253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty