Provider Demographics
NPI:1407560840
Name:GOOD NURSE HOME CARE LLC
Entity Type:Organization
Organization Name:GOOD NURSE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE RN BSN
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:RIVERA VEGA
Authorized Official - Suffix:SR
Authorized Official - Credentials:BSN
Authorized Official - Phone:787-201-3130
Mailing Address - Street 1:HC 1 BOX 18531
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-7760
Mailing Address - Country:US
Mailing Address - Phone:787-201-3130
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 6618 KM 0.9 BARRIO MOROVIS SUR SECTOR VEREDA
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687
Practice Address - Country:US
Practice Address - Phone:787-201-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No163WI0600XNursing Service ProvidersRegistered NurseInfection ControlGroup - Multi-Specialty
No163WX1500XNursing Service ProvidersRegistered NurseOstomy CareGroup - Multi-Specialty