Healthcare Provider Details

I. General information

NPI: 1912835687
Provider Name (Legal Business Name): SOFIA ROSE GOODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S MAIN ST
LIMA OH
45804-1240
US

IV. Provider business mailing address

530 S MAIN ST
LIMA OH
45804-1500
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-1168
  • Fax:
Mailing address:
  • Phone: 419-222-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: