Healthcare Provider Details

I. General information

NPI: 1225801616
Provider Name (Legal Business Name): GOLDEN HEARTS LIFESTYLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16304 MENDOTA AVE
MAPLE HEIGHTS OH
44137-4818
US

IV. Provider business mailing address

16304 MENDOTA AVE
MAPLE HEIGHTS OH
44137-4818
US

V. Phone/Fax

Practice location:
  • Phone: 216-355-0007
  • Fax:
Mailing address:
  • Phone: 216-355-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: KINOSHA SPENCER
Title or Position: OWNER
Credential:
Phone: 216-355-0007