Provider Demographics
NPI:1801391982
Name:GODAELLI HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:GODAELLI HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEJEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, RN
Authorized Official - Phone:240-320-4996
Mailing Address - Street 1:170 WOODSTREAM BLVD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-4629
Mailing Address - Country:US
Mailing Address - Phone:240-320-4996
Mailing Address - Fax:
Practice Address - Street 1:1549 OLD BRIDGE RD STE 303
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2737
Practice Address - Country:US
Practice Address - Phone:703-870-0738
Practice Address - Fax:540-783-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-1814251J00000X
261QM1300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty