Healthcare Provider Details

I. General information

NPI: 1720815459
Provider Name (Legal Business Name): GOODWILL CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4931 KALE GARDEN CT
KATY TX
77449-4874
US

IV. Provider business mailing address

4931 KALE GARDEN CT
KATY TX
77449-4874
US

V. Phone/Fax

Practice location:
  • Phone: 832-449-9732
  • Fax:
Mailing address:
  • Phone: 832-731-1448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: OLANIKE M PETERS
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 832-731-1448