Provider Demographics
NPI:1740806611
Name:GOOD HEALTH RESIDENTIAL SERVICES INC.
Entity Type:Organization
Organization Name:GOOD HEALTH RESIDENTIAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADEDAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:FAPONLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MSN
Authorized Official - Phone:202-805-2797
Mailing Address - Street 1:8806 GOLDEN TREE LN
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3221
Mailing Address - Country:US
Mailing Address - Phone:202-805-2797
Mailing Address - Fax:
Practice Address - Street 1:8806 GOLDEN TREE LN
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3221
Practice Address - Country:US
Practice Address - Phone:202-805-2797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD150232800Medicaid