Provider Demographics
NPI:1083285803
Name:GODLY CARE AND ASSOCIATES
Entity Type:Organization
Organization Name:GODLY CARE AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIE CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-291-6773
Mailing Address - Street 1:3641 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7115
Mailing Address - Country:US
Mailing Address - Phone:786-291-6773
Mailing Address - Fax:305-627-3667
Practice Address - Street 1:3641 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7115
Practice Address - Country:US
Practice Address - Phone:786-291-6773
Practice Address - Fax:305-627-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0215Medicaid