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General NPI Number Information
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NPI Number | 1356836100
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Entity Type | Organization
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Legal Business Name | GOODMAN SERVICES, LLC
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 2132 22ND AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33712-3117
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Country | US
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Telephone | 863-512-6003
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Fax | 863-213-4060
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Provider Business Mailing Address
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Address Line | PO BOX 92105
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City | LAKELAND
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State | FL
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Zip | 33804-2105
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Country | US
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Telephone | 863-512-6003
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Fax | 863-213-4060
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | LEROY GOODMAN JR.
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Credential |
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Telephone | 863-512-6003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State |
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