Provider Demographics
NPI:1104624105
Name:GOLDENHEART INVESTMENT
Entity type:Organization
Organization Name:GOLDENHEART INVESTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:TALICE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-807-5631
Mailing Address - Street 1:3819 LYNDALE AVE N # 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2166
Mailing Address - Country:US
Mailing Address - Phone:612-231-6664
Mailing Address - Fax:
Practice Address - Street 1:3819 LYNDALE AVE N # 1
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2166
Practice Address - Country:US
Practice Address - Phone:612-231-6664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health