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General NPI Number Information
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NPI Number | 1770585036
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Entity Type | Organization
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Legal Business Name | HEARTS OF GOLD, INC
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 38 5TH AVE
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City | SHELL LAKE
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State | WI
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Zip | 54871-4441
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Country | US
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Telephone | 715-468-2931
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 220
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City | SHELL LAKE
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State | WI
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Zip | 54871-0220
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | SUE DODD
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Credential |
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Telephone | 715-468-2931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 304
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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