Provider Demographics
NPI:1083863351
Name:GODIA HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:GODIA HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ONSERIO
Authorized Official - Last Name:MISARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-220-0647
Mailing Address - Street 1:14764 HALLMARK DR
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7460
Mailing Address - Country:US
Mailing Address - Phone:952-220-0647
Mailing Address - Fax:763-533-4374
Practice Address - Street 1:14764 HALLMARK DR
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7460
Practice Address - Country:US
Practice Address - Phone:952-220-0647
Practice Address - Fax:763-533-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home