Healthcare Provider Details

I. General information

NPI: 1114491107
Provider Name (Legal Business Name): GODS SPEED HOME HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W WASHINGTON ST STE 213
SUFFOLK VA
23434-5320
US

IV. Provider business mailing address

309 FESTIVAL CT
SUFFOLK VA
23434-9255
US

V. Phone/Fax

Practice location:
  • Phone: 757-536-0080
  • Fax: 757-925-4791
Mailing address:
  • Phone: 757-536-0080
  • Fax: 757-925-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NATHANIEL JACKSON
Title or Position: OWNER
Credential:
Phone: 757-536-0080