Healthcare Provider Details

I. General information

NPI: 1487928024
Provider Name (Legal Business Name): GOODWILL HEALTHCARE TEAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W NOLANA AVE STE N
MCALLEN TX
78504-3747
US

IV. Provider business mailing address

1111 W NOLANA AVE STE N
MCALLEN TX
78504-3747
US

V. Phone/Fax

Practice location:
  • Phone: 956-540-8695
  • Fax: 956-540-8699
Mailing address:
  • Phone: 956-540-8695
  • Fax: 956-540-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE LUIS FLORES
Title or Position: DIRECTOR
Credential:
Phone: 956-540-8695