Provider Demographics
NPI:1891141347
Name:GOODNESS GRACE AND FAVOR LLC
Entity Type:Organization
Organization Name:GOODNESS GRACE AND FAVOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ADERONKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADESOKAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:832-800-7135
Mailing Address - Street 1:829 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:TX
Mailing Address - Zip Code:77445-9804
Mailing Address - Country:US
Mailing Address - Phone:832-800-7135
Mailing Address - Fax:
Practice Address - Street 1:829 12TH STREET
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:TX
Practice Address - Zip Code:77445-9804
Practice Address - Country:US
Practice Address - Phone:832-800-7135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies