Organization
A HEART OF GOLD HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEIGHANN JOHNSON (OWNER)
(928) 250-9436
Entity
Organization
Contact information
Practice address
1958 E RENEGADE TRL, SAN TAN VALLEY, AZ 85143-4460
(928) 250-9436
Mailing address
1958 E RENEGADE TRL, SAN TAN VALLEY, AZ 85143-4460
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/23/2024
Last updated
02/23/2024
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