Healthcare Provider Details

I. General information

NPI: 1568948230
Provider Name (Legal Business Name): HEART OF GOLD HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WASHINGTON BLVD # 301
DETROIT MI
48226-1718
US

IV. Provider business mailing address

1420 WASHINGTON BLVD # 301
DETROIT MI
48226-1718
US

V. Phone/Fax

Practice location:
  • Phone: 810-660-1528
  • Fax:
Mailing address:
  • Phone: 810-660-1528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: DAVINA M JOHNSON
Title or Position: OWNER
Credential:
Phone: 810-660-1528