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General NPI Number Information
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NPI Number | 1215428859
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Entity Type | Organization
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Legal Business Name | GOOD CUSTODIAN SERVICES, LLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 15426 BEVANWOOD DR
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City | WOODBRIDGE
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State | VA
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Zip | 22193-5716
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Country | US
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Telephone | 703-580-1077
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Fax |
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Provider Business Mailing Address
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Address Line | 15426 BEVANWOOD DR
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City | WOODBRIDGE
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State | VA
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Zip | 22193-5716
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Country | US
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Telephone | 703-580-1077
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. PHILOMENA DESMOND
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Credential |
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Telephone | 703-580-1077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | IM675
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License Number State | VA
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