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General NPI Number Information
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NPI Number | 1306285168
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Entity Type | Organization
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Legal Business Name | GOODHEAVEN AFCH, INC
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Dates
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Enumeration Date | 06/14/2013
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Last Update Date | 06/14/2013
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Provider Practice Location Address
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Address Line | 124 BELLAMY TRL
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City | SEBASTIAN
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State | FL
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Zip | 32958-6483
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Country | US
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Telephone | 772-646-1939
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Fax | 772-589-7328
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Provider Business Mailing Address
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Address Line | 124 BELLAMY TRL
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City | SEBASTIAN
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State | FL
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Zip | 32958-6483
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Country | US
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Telephone | 772-646-1939
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Fax | 772-589-7328
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | EVELYN BARTON
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Credential | LPN
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Telephone | 772-646-1939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 6906452
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License Number State | FL
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