MEDICARE: PREMIER GOLDEN HEART HEALTH CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	010291	TX

General Provider Information

NPI Number	:	1033279252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER GOLDEN HEART HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	2412 OLD NORTH RD STE 101K
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76209-1524
Country	:	US
Telephone Number	:	940-566-4999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 OLD NORTH RD STE 101K
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76209-1524
Country	:	US
Telephone Number	:	940-566-4999
Fax Number	:	940-566-4992

Authorized Official
Title or Position	:	CEO
Name	:	ITATA ITATA
Credential	:	ESQ.
Telephone Number	:	940-566-4999

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/18/2022

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