Healthcare Provider Details

I. General information

NPI: 1285183806
Provider Name (Legal Business Name): HEART OF GOLD HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FOXHALL DRIVE
LEXINGTON SC
29073-8184
US

IV. Provider business mailing address

200 FOXHALL DRIVE
LEXINGTON SC
29073-8184
US

V. Phone/Fax

Practice location:
  • Phone: 843-909-4713
  • Fax:
Mailing address:
  • Phone: 843-909-4713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberP48803
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberP48803
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberP48803
License Number StateSC

VIII. Authorized Official

Name: LIONEL YATES
Title or Position: OWNER/LPN
Credential:
Phone: 843-909-4713