MEDICARE: GOODWILL HEALTHCARE 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	251E00000X	Home Health Agency	1010491	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871644146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODWILL HEALTHCARE SERVICES INC.

Provider Business Mailing Address
First Line	:	9942 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1831
Country	:	US
Telephone Number	:	773-779-8556
Fax Number	:	773-779-8660

Provider Business Practice Location Address
First Line	:	9942 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1831
Country	:	US
Telephone Number	:	773-779-8556
Fax Number	:	773-779-8660

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. BEATRICE N MBAOCHA
Credential	:
Telephone Number	:	708-612-5628

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	11/16/2023

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Directions to “GOODWILL HEALTHCARE SERVICES INC. ” Practice Location

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