Healthcare Provider Details

I. General information

NPI: 1093520090
Provider Name (Legal Business Name): GOLD HEARTH HOLISTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 E MAIN ST
GRASS VALLEY CA
95945-5718
US

IV. Provider business mailing address

10481 CRESTVIEW DR
GRASS VALLEY CA
95949-9170
US

V. Phone/Fax

Practice location:
  • Phone: 808-315-3677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: VERONICA WEBB
Title or Position: OWNER
Credential:
Phone: 808-315-3677