Healthcare Provider Details

I. General information

NPI: 1831881481
Provider Name (Legal Business Name): GOODWIN HOUSE HOME AND COMMUNITY BASED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 S JEFFERSON ST
FALLS CHURCH VA
22041-3145
US

IV. Provider business mailing address

4800 FILLMORE AVE
ALEXANDRIA VA
22311-5070
US

V. Phone/Fax

Practice location:
  • Phone: 703-578-7469
  • Fax:
Mailing address:
  • Phone: 703-578-7195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELINDA T GREN
Title or Position: VP PERFORMANCE AND OPERATIONS, HCBS
Credential:
Phone: 703-578-7195