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General NPI Number Information
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NPI Number | 1114491107
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Entity Type | Organization
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Legal Business Name | GODS SPEED HOME HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 01/14/2019
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 425 W WASHINGTON ST STE 213
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City | SUFFOLK
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State | VA
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Zip | 23434-5320
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Country | US
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Telephone | 757-536-0080
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Fax | 757-925-4791
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Provider Business Mailing Address
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Address Line | 309 FESTIVAL CT
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City | SUFFOLK
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State | VA
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Zip | 23434-9255
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Country | US
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Telephone | 757-536-0080
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Fax | 757-925-4791
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Authorized Official
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Title or Position | OWNER
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Name | NATHANIEL JACKSON
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Credential |
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Telephone | 757-536-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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