Provider Demographics
NPI:1003292160
Name:GODUSI LLC
Entity Type:Organization
Organization Name:GODUSI LLC
Other - Org Name:HOME INSTEAD SENIOR CARE OF WILMINGTON NC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GHODDOUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:919-457-3547
Mailing Address - Street 1:2505 S 17TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7992
Mailing Address - Country:US
Mailing Address - Phone:910-342-0455
Mailing Address - Fax:
Practice Address - Street 1:2505 S 17TH ST STE 110
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7992
Practice Address - Country:US
Practice Address - Phone:910-342-0455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3797253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care