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General NPI Number Information
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NPI Number | 1043767684
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Entity Type | Organization
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Legal Business Name | HEART OF GOLD HOME CARE
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 592 NORMAN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06605-1132
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Country | US
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Telephone | 203-360-0381
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Fax |
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Provider Business Mailing Address
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Address Line | 592 NORMAN STREET
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City | BRIDGEPORT
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State | CT
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Zip | 06604-1132
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Country | US
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Telephone | 203-360-0381
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISS BELYNDA CONSTANT I
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Credential | DIRECTOR
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Telephone | 203-360-0381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HCA-0001155
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License Number State | CT
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