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General NPI Number Information
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NPI Number | 1609141498
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Entity Type | Organization
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Legal Business Name | GOOD OLD HOME CARE SERVICES
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 924 N JOHNSTON AVE
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City | ROCKFORD
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State | IL
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Zip | 61101-5246
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Country | US
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Telephone | 815-262-6780
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Fax | 815-708-6163
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Provider Business Mailing Address
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Address Line | PO BOX 6286
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City | ROCKFORD
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State | IL
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Zip | 61125-1286
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Country | US
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Telephone | 815-262-6780
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Fax | 815-708-6163
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MRS. JODI DANDRIDGE
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Credential |
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Telephone | 815-262-6780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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