Healthcare Provider Details

I. General information

NPI: 1740692235
Provider Name (Legal Business Name): INDIA GOODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3793 GREEN RD
BEACHWOOD OH
44122-5705
US

IV. Provider business mailing address

1520 RUSSELL DR APT D
STREETSBORO OH
44241-8355
US

V. Phone/Fax

Practice location:
  • Phone: 216-376-6640
  • Fax:
Mailing address:
  • Phone: 121-637-6664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberRN448674
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: