Healthcare Provider Details

I. General information

NPI: 1063245934
Provider Name (Legal Business Name): GOALS SUPPORTIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4139 DUFFY CT
FAIRFIELD TOWNSHIP OH
45011-9389
US

IV. Provider business mailing address

4139 DUFFY CT
FAIRFIELD TOWNSHIP OH
45011-9389
US

V. Phone/Fax

Practice location:
  • Phone: 513-212-5655
  • Fax:
Mailing address:
  • Phone: 513-212-5655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: SILVA RICHARDSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 513-212-5655