Provider Demographics
NPI:1801200787
Name:GOODALE INNOVATIONS, LLC
Entity Type:Organization
Organization Name:GOODALE INNOVATIONS, LLC
Other - Org Name:DEL MAR HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODALE
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:361-882-4267
Mailing Address - Street 1:5718 MCARDLE RD
Mailing Address - Street 2:101
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-3455
Mailing Address - Country:US
Mailing Address - Phone:361-882-4267
Mailing Address - Fax:361-882-4212
Practice Address - Street 1:5718 MCARDLE RD
Practice Address - Street 2:101
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3455
Practice Address - Country:US
Practice Address - Phone:361-882-4267
Practice Address - Fax:361-882-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80556332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment