Provider Demographics
NPI:1699143388
Name:A HEART OF GOLD HOME HEALTH LLC
Entity type:Organization
Organization Name:A HEART OF GOLD HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNTA
Authorized Official - Middle Name:LEWAI
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-227-3344
Mailing Address - Street 1:3640 S PLAZA TRL STE 201
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3363
Mailing Address - Country:US
Mailing Address - Phone:757-227-3344
Mailing Address - Fax:757-227-3344
Practice Address - Street 1:3640 S PLAZA TRL STE 201
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3363
Practice Address - Country:US
Practice Address - Phone:757-227-3344
Practice Address - Fax:757-227-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health