Healthcare Provider Details

I. General information

NPI: 1164347597
Provider Name (Legal Business Name): GOLDEN HEARTS SENIOR COMPANION HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 S SHRANK RD
INDEPENDENCE MO
64055-2957
US

IV. Provider business mailing address

3013 S SHRANK RD
INDEPENDENCE MO
64055-2957
US

V. Phone/Fax

Practice location:
  • Phone: 816-284-6999
  • Fax:
Mailing address:
  • Phone: 816-284-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ELSIE JACKSON
Title or Position: PRESIDENT
Credential:
Phone: 816-284-6999