# A HEART OF GOLD HOME LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508622960
- **Authorized official:** LEIGHANN JOHNSON (OWNER)
- **Authorized official phone:** (928) 250-9436

## Contact information

- **Practice address:** 1958 E RENEGADE TRL, SAN TAN VALLEY, AZ 85143-4460
- **Practice address phone:** (928) 250-9436
- **Mailing address:** 1958 E RENEGADE TRL, SAN TAN VALLEY, AZ 85143-4460

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 02/23/2024
- **Last updated:** 02/23/2024