Provider Demographics
NPI:1356673313
Name:GOODWIN HOUSE HOME AND COMMUNITY BASED SERVICES INC
Entity Type:Organization
Organization Name:GOODWIN HOUSE HOME AND COMMUNITY BASED SERVICES INC
Other - Org Name:GOODWIN HOUSE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-578-7554
Mailing Address - Street 1:4800 FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-5070
Mailing Address - Country:US
Mailing Address - Phone:703-824-1390
Mailing Address - Fax:703-782-8835
Practice Address - Street 1:4800 FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-5070
Practice Address - Country:US
Practice Address - Phone:703-824-1390
Practice Address - Fax:703-828-9892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOODWIN HOUSE INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-02
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health