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General NPI Number Information
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NPI Number | 1194442921
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Entity Type | Organization
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Legal Business Name | HEART OF GOLD DEVELOPMENTAL AND DISABILITIES HEALTH CARE SERVICES,INC
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 717 PALMETTO AVE
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City | COLUMBUS
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State | GA
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Zip | 31906-4025
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Country | US
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Telephone | 706-505-1116
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Fax | 706-505-1116
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Provider Business Mailing Address
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Address Line | 9145 GARRETT LAKE DR
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City | MIDLAND
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State | GA
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Zip | 31820-4391
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Country | US
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Telephone | 706-577-1687
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAVADA PORTIER
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Credential | LPN
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Telephone | 706-577-1687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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