MEDICARE: GOOD FAITH 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1811131675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD FAITH INC

Provider Business Mailing Address
First Line	:	6040 EARLE BROWN DR
Second Line	:	SUITE 260
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-2514
Country	:	US
Telephone Number	:	763-208-9272
Fax Number	:	763-503-9451

Provider Business Practice Location Address
First Line	:	6500 BROOKLYN BLVD
Second Line	:	SUITE 200
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1754
Country	:	US
Telephone Number	:	763-438-2936
Fax Number	:	763-503-9451

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MINIRU OMOTAYO ALAWIYE
Credential	:
Telephone Number	:	763-438-2936

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	10/21/2013

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Directions to “GOOD FAITH INC ” Practice Location

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