Healthcare Provider Details

I. General information

NPI: 1164477162
Provider Name (Legal Business Name): MEL'S HEART OF GOLD SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W BRIDGE ST
SAINT MARTINVILLE LA
70582-3322
US

IV. Provider business mailing address

421 W BRIDGE ST
SAINT MARTINVILLE LA
70582-3322
US

V. Phone/Fax

Practice location:
  • Phone: 337-315-5643
  • Fax: 337-394-3771
Mailing address:
  • Phone: 337-315-5643
  • Fax: 337-394-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number36185615K
License Number StateLA

VIII. Authorized Official

Name: MRS. MARILYN MARIE LIVINGSTON
Title or Position: OWNER
Credential:
Phone: 337-394-3771