MEDICARE: HEART OF GOLD ADULT DAY CARE 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	343800000X	Secured Medical Transport (VAN)

General Provider Information

NPI Number	:	1396437539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART OF GOLD ADULT DAY CARE LLC

Provider Business Mailing Address
First Line	:	2904 TRIMMIER RD STE B16
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-6038
Country	:	US
Telephone Number	:	254-245-9076
Fax Number	:

Provider Business Practice Location Address
First Line	:	2904 TRIMMIER RD STE B16
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-6038
Country	:	US
Telephone Number	:	254-245-9076
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DONNETTA BILLS
Credential	:
Telephone Number	:	254-245-9076

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	06/22/2023

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