Healthcare Provider Details

I. General information

NPI: 1164653168
Provider Name (Legal Business Name): GOOD HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MAIN ST SUITE D
RED SPRINGS NC
28377-1512
US

IV. Provider business mailing address

120 S MAIN ST SUITE D
RED SPRINGS NC
28377-1512
US

V. Phone/Fax

Practice location:
  • Phone: 910-987-8380
  • Fax:
Mailing address:
  • Phone: 910-987-8380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY ANN JOHNSON
Title or Position: OWNER
Credential:
Phone: 910-987-8380