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General NPI Number Information
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NPI Number | 1144969296
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Entity Type | Organization
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Legal Business Name | GOODWIN HOUSE HOME AND COMMUNITY BASED SERVICES
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 5000 FAIRBANKS AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-1246
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Country | US
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Telephone | 703-578-7195
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 FAIRBANKS AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-1246
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Country | US
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Telephone | 703-797-3869
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Fax |
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Authorized Official
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Title or Position | VP PERFORMANCE AND OPERATIONS, HCBS
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Name | MELINDA T GREN
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Credential | PT, DPT
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Telephone | 703-578-7195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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