Provider Demographics
NPI:1780459982
Name:HEART OF GOLD GROUP HOME LLC
Entity type:Organization
Organization Name:HEART OF GOLD GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-245-9076
Mailing Address - Street 1:2904 TRIMMIER RD STE B16
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6038
Mailing Address - Country:US
Mailing Address - Phone:254-245-9076
Mailing Address - Fax:
Practice Address - Street 1:2904 TRIMMIER RD STE B17
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6038
Practice Address - Country:US
Practice Address - Phone:254-245-9076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities