=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548456932
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOODMAN CARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2007
-----------------------------------------------------
Last Update Date | 09/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1320 W D ST SUITE 1-A
-----------------------------------------------------
City | NORTH WILKESBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28659-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-838-4040
-----------------------------------------------------
Fax | 336-838-2060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1320 W D ST SUITE 1-A
-----------------------------------------------------
City | NORTH WILKESBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28659-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-838-4040
-----------------------------------------------------
Fax | 336-838-2060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. MICHAEL LYNN GOODMAN
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 336-838-4040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC3529
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------