MEDICARE: GOODWILL HOSPICE SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1336764109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODWILL HOSPICE SERVICES INC

Provider Business Mailing Address
First Line	:	22151 VENTURA BLVD STE 204
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1666
Country	:	US
Telephone Number	:	818-468-3928
Fax Number	:

Provider Business Practice Location Address
First Line	:	22151 VENTURA BLVD STE 204
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1666
Country	:	US
Telephone Number	:	818-468-3928
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MIKE JAVANMARD
Credential	:
Telephone Number	:	818-468-3928

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	06/08/2020

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