Provider Demographics
NPI:1972123446
Name:GOLDEN HEART CARE
Entity type:Organization
Organization Name:GOLDEN HEART CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLICANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-606-1907
Mailing Address - Street 1:21620 N 19TH AVE STE A6
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2716
Mailing Address - Country:US
Mailing Address - Phone:623-606-1907
Mailing Address - Fax:623-248-4570
Practice Address - Street 1:7250 N 23RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7715
Practice Address - Country:US
Practice Address - Phone:623-377-8983
Practice Address - Fax:623-476-5646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health