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General NPI Number Information
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NPI Number | 1629069851
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Entity Type | Organization
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Legal Business Name | GOODWIN HOUSE INCORPORATED
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Dates
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Enumeration Date | 11/05/2005
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 4800 FILLMORE AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-5070
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Country | US
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Telephone | 703-824-1290
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Fax | 703-824-1241
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Provider Business Mailing Address
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Address Line | 4800 FILLMORE AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-5070
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Country | US
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Telephone | 703-824-1290
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Fax | 703-824-1241
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Authorized Official
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Title or Position | CEO
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Name | MISS KATHLEEN S ANDERSON
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Credential |
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Telephone | 703-824-1355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH2560
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License Number State | VA
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