Provider Demographics
NPI:1649722000
Name:GOLDEN HEART CARE
Entity type:Organization
Organization Name:GOLDEN HEART CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JAVIER
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:623-248-4570
Practice Address - Street 1:21620 N 19TH AVE STE A6
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2716
Practice Address - Country:US
Practice Address - Phone:623-248-1162
Practice Address - Fax:623-248-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health