Healthcare Provider Details

I. General information

NPI: 1033701099
Provider Name (Legal Business Name): BRENDA GOINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 04/17/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 GOODSON RD
RAINELLE WV
25962-6820
US

IV. Provider business mailing address

52 GOODSON RD
RAINELLE WV
25962-6820
US

V. Phone/Fax

Practice location:
  • Phone: 304-438-1433
  • Fax:
Mailing address:
  • Phone: 304-438-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: