MEDICARE: THE GOOD NEIGHBORS 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1922875251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GOOD NEIGHBORS LLC

Provider Business Mailing Address
First Line	:	928 BANYAN DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5204
Country	:	US
Telephone Number	:	757-477-3165
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 LANDMARK SQ STE 104
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-6872
Country	:	US
Telephone Number	:	757-477-3165
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	TIMOTHY JOHNSON
Credential	:
Telephone Number	:	757-477-3165

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	01/20/2024

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