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General NPI Number Information
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NPI Number | 1053176461
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Entity Type | Organization
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Legal Business Name | GOODWILL HEALTH CARE LLC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 6655 W SAHARA AVE STE 113-114
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City | LAS VEGAS
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State | NV
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Zip | 89146-0842
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Country | US
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Telephone | 615-713-7465
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Fax |
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Provider Business Mailing Address
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Address Line | 192 MACOBY RUN ST
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City | LAS VEGAS
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State | NV
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Zip | 89148-2628
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Country | US
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Telephone | 615-713-7465
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | EDSEL GAY MARTINEZ
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Credential | REGISTERED NURSE
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Telephone | 808-783-3278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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