MEDICARE: GOLDEN HEARTS HOME HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	385H00000X	Respite Care
3	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487463113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN HEARTS HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	3405 TYRE NECK RD STE 1
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-3333
Country	:	US
Telephone Number	:	757-536-5321
Fax Number	:	757-835-0177

Provider Business Practice Location Address
First Line	:	3405 TYRE NECK RD
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-3333
Country	:	US
Telephone Number	:	948-220-9031
Fax Number	:	757-835-0177

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CANIESHA DESHE HORNE
Credential	:
Telephone Number	:	948-220-9031

Provider Enumeration Date	:	01/07/2025
Last Update Date	:	01/06/2026

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