MEDICARE: GOODWILL HOME CARE AGENCY, LLC

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

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	:	1912631482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODWILL HOME CARE AGENCY, LLC

Provider Business Mailing Address
First Line	:	5421 OLD POOLE RD STE 105
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-3285
Country	:	US
Telephone Number	:	800-998-0929
Fax Number	:

Provider Business Practice Location Address
First Line	:	5421 OLD POOLE RD STE 105
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-3285
Country	:	US
Telephone Number	:	800-998-0929
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAQUEL THOMAS
Credential	:
Telephone Number	:	336-587-8797

Provider Enumeration Date	:	07/12/2022
Last Update Date	:	10/02/2023

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