Provider Demographics
NPI:1235772716
Name:GOOD HOPE HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:GOOD HOPE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NDEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-988-0942
Mailing Address - Street 1:12020 SUNRISE VALLEY DR STE 139
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3440
Mailing Address - Country:US
Mailing Address - Phone:469-988-0942
Mailing Address - Fax:
Practice Address - Street 1:12020 SUNRISE VALLEY DR STE 139
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3440
Practice Address - Country:US
Practice Address - Phone:469-988-0942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care