Provider Demographics
NPI:1609141498
Name:GOOD OLD HOME CARE SERVICES
Entity Type:Organization
Organization Name:GOOD OLD HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:DANDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-262-6780
Mailing Address - Street 1:PO BOX 6286
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61125-1286
Mailing Address - Country:US
Mailing Address - Phone:815-262-6780
Mailing Address - Fax:815-708-6163
Practice Address - Street 1:924 N JOHNSTON AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-5246
Practice Address - Country:US
Practice Address - Phone:815-262-6780
Practice Address - Fax:815-708-6163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health