Healthcare Provider Details

I. General information

NPI: 1356255327
Provider Name (Legal Business Name): CHRISTINE L GOODRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIEL I GOODRICH

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 NE PLUM AVE
EARLHAM IA
50072-1047
US

IV. Provider business mailing address

360 NE PLUM AVE
EARLHAM IA
50072-1047
US

V. Phone/Fax

Practice location:
  • Phone: 515-204-7304
  • Fax:
Mailing address:
  • Phone: 515-204-7304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: