Organization
GOLDEN HEART CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS VILLICANA (PRESIDENT)
(623) 248-1162
Entity
Organization
Contact information
Practice address
21620 N 19TH AVE STE A6, PHOENIX, AZ 85027-2716
(623) 248-1162
(623) 248-4570
Mailing address
21620 N 19TH AVE STE A6, PHOENIX, AZ 85027-2716
(623) 606-1907
(623) 248-4570
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
11/01/2016
Last updated
04/23/2026
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