Provider Demographics
NPI:1528200987
Name:GOODWILL HOME HEALTH LLC
Entity Type:Organization
Organization Name:GOODWILL HOME HEALTH LLC
Other - Org Name:AVIATOR HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-548-2163
Mailing Address - Street 1:321 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3519
Mailing Address - Country:US
Mailing Address - Phone:972-548-2163
Mailing Address - Fax:972-347-6306
Practice Address - Street 1:321 N CENTRAL EXPY
Practice Address - Street 2:SUITE 350
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3519
Practice Address - Country:US
Practice Address - Phone:972-548-2163
Practice Address - Fax:972-347-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
015662OtherSTATE LICENSE
HH531KOtherBCBS PROVIDER NUMBER
015662OtherSTATE LICENSE