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General NPI Number Information
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NPI Number | 1508544941
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Entity Type | Organization
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Legal Business Name | GOODWILL HOMES LLC
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 13126 MERCURY LN
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City | FAIRFAX
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State | VA
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Zip | 22033-3711
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Country | US
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Telephone | 202-258-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 13126 MERCURY LN
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City | FAIRFAX
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State | VA
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Zip | 22033-3711
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Country | US
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Telephone | 202-258-3344
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROGER LEYOU
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Credential |
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Telephone | 202-258-3344
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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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