MEDICARE: MEL'S HEART OF GOLD SERVICES

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	313M00000X	Nursing Facility/Intermediate Care Facility	36185615K	LA

General Provider Information

NPI Number	:	1164477162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEL'S HEART OF GOLD SERVICES

Provider Business Mailing Address
First Line	:	421 W BRIDGE ST
Second Line	:
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-3322
Country	:	US
Telephone Number	:	337-315-5643
Fax Number	:	337-394-3771

Provider Business Practice Location Address
First Line	:	421 W BRIDGE ST
Second Line	:
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-3322
Country	:	US
Telephone Number	:	337-315-5643
Fax Number	:	337-394-3771

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARILYN MARIE LIVINGSTON
Credential	:
Telephone Number	:	337-394-3771

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/22/2020

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