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General NPI Number Information
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NPI Number | 1871644146
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Entity Type | Organization
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Legal Business Name | GOODWILL HEALTHCARE SERVICES INC.
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 9942 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-1831
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Country | US
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Telephone | 773-779-8556
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Fax | 773-779-8660
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Provider Business Mailing Address
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Address Line | 9942 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-1831
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Country | US
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Telephone | 773-779-8556
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Fax | 773-779-8660
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BEATRICE N MBAOCHA
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Credential |
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Telephone | 708-612-5628
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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 | 1010491
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License Number State | IL
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