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General NPI Number Information
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NPI Number | 1255899076
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Entity Type | Organization
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Legal Business Name | GOODWILL VENTURES INC
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 820 ANTIGUA ST
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City | LAS VEGAS
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State | NV
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Zip | 89145-6142
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Country | US
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Telephone | 702-358-9917
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Fax |
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Provider Business Mailing Address
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Address Line | 6149 GLENBOROUGH ST
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City | LAS VEGAS
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State | NV
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Zip | 89115-6017
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | ROSVI ALBEZA
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Credential |
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Telephone | 702-358-9917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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