Provider Demographics
NPI:1881241313
Name:GOLDEN HEART SENIOR CARE
Entity type:Organization
Organization Name:GOLDEN HEART SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-369-0481
Mailing Address - Street 1:6001 EGAN DR STE 160
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4920
Mailing Address - Country:US
Mailing Address - Phone:952-226-4653
Mailing Address - Fax:
Practice Address - Street 1:6001 EGAN DR STE 160
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-4920
Practice Address - Country:US
Practice Address - Phone:952-226-4653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health