MEDICARE: GOOD DEEDS HOME HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	BL005564032014	SC

General Provider Information

NPI Number	:	1801207329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD DEEDS HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	1815 GERVAIS ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3554
Country	:	US
Telephone Number	:	803-450-2602
Fax Number	:	803-450-2604

Provider Business Practice Location Address
First Line	:	1815 GERVAIS ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3554
Country	:	US
Telephone Number	:	803-450-2602
Fax Number	:	803-450-2604

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LAMONTE JOHNSON
Credential	:
Telephone Number	:	803-450-2602

Provider Enumeration Date	:	05/19/2014
Last Update Date	:	05/19/2014

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