=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073945457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN HEART CAREGIVERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2013
-----------------------------------------------------
Last Update Date | 08/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7770 MICHIGAN RD SUITE: D
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46268-2375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-871-2600
-----------------------------------------------------
Fax | 317-871-2714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7770 MICHIGAN RD SUITE: D
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46268-2375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-871-2600
-----------------------------------------------------
Fax | 317-871-2714
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | EBONI HARRISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-871-2600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 13-013270-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------