Healthcare Provider Details

I. General information

NPI: 1467385468
Provider Name (Legal Business Name): HEART OF GOLD HOME HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E MAIN ST STE 236
MESA AZ
85203-9018
US

IV. Provider business mailing address

1616 E MAIN ST STE 236
MESA AZ
85203-9018
US

V. Phone/Fax

Practice location:
  • Phone: 800-375-1066
  • Fax: 800-375-1066
Mailing address:
  • Phone: 800-375-1066
  • Fax: 800-375-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DEONDRALIQUE GREENE
Title or Position: ADMINISTRATOR
Credential:
Phone: 817-404-6150