Provider Demographics
NPI:1285389411
Name:COMPASSIONATE GOLDEN HEARTS LLC
Entity type:Organization
Organization Name:COMPASSIONATE GOLDEN HEARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NELLIE
Authorized Official - Middle Name:WAMBUI
Authorized Official - Last Name:MBOTE
Authorized Official - Suffix:
Authorized Official - Credentials:LAB DIRECTOR
Authorized Official - Phone:816-209-9237
Mailing Address - Street 1:4012 SW FLINTROCK DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4871
Mailing Address - Country:US
Mailing Address - Phone:816-209-9237
Mailing Address - Fax:
Practice Address - Street 1:4012 SW FLINTROCK DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4871
Practice Address - Country:US
Practice Address - Phone:816-209-9237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory