Healthcare Provider Details

I. General information

NPI: 1336888239
Provider Name (Legal Business Name): GOOD CUSTODIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15426 BEVANWOOD DR
WOODBRIDGE VA
22193-5716
US

IV. Provider business mailing address

15426 BEVANWOOD DR
WOODBRIDGE VA
22193-5716
US

V. Phone/Fax

Practice location:
  • Phone: 571-589-7866
  • Fax: 703-373-2813
Mailing address:
  • Phone: 571-589-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: PHILOMENA DESMOND-OGUGUA
Title or Position: MANAGER
Credential:
Phone: 571-589-7866