MEDICARE: GOLDEN HEARTS, INC.

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	251C00000X	Developmentally Disabled Services Day Training Agency	1009163	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346633922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN HEARTS, INC.

Provider Business Mailing Address
First Line	:	6401 BLACKBERRY ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-2135
Country	:	US
Telephone Number	:	907-344-2729
Fax Number	:	907-677-1105

Provider Business Practice Location Address
First Line	:	6401 BLACKBERRY ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-2135
Country	:	US
Telephone Number	:	907-344-2729
Fax Number	:	907-677-1105

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DONNA SUE HAYES
Credential	:
Telephone Number	:	907-344-2729

Provider Enumeration Date	:	03/06/2015
Last Update Date	:	03/06/2015

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Directions to “GOLDEN HEARTS, INC. ” Practice Location

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