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General NPI Number Information
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NPI Number | 1033279252
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Entity Type | Organization
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Legal Business Name | PREMIER GOLDEN HEART HEALTH CARE SERVICES LLC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 2412 OLD NORTH RD STE 101K
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City | DENTON
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State | TX
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Zip | 76209-1524
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Country | US
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Telephone | 940-566-4999
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Fax | 940-566-4992
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Provider Business Mailing Address
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Address Line | 2412 OLD NORTH RD STE 101K
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City | DENTON
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State | TX
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Zip | 76209-1524
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Country | US
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Telephone | 940-566-4999
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ITATA ITATA
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Credential | ESQ.
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Telephone | 940-566-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 010291
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License Number State | TX
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