| Organization Name: | SR GOLDEN HEART PROVIDER CARE AND TRANSPORTATION SERVICES, LLC |
| NPI Number: | 1396023784 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEVAO FAYIA SAFFA (PROGRAM MANAGER) |
| Mailing Address: | 7100 Regency Square Blvd Suite 203-5 Houston |
| State: | TX US |
| Postal Code: | 770363202 |
| Phone Number: | 7137842480 |
| Fax Number: | 7137842860 |
| NPI Enumeration Date: | 08/02/2011 |
| NPI Last Update Date: | 08/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320600000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |