Provider Demographics
NPI:1932649456
Name:GOODWORKS AT HOME LLC
Entity Type:Organization
Organization Name:GOODWORKS AT HOME LLC
Other - Org Name:THE SUMMIT AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOJAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-762-2310
Mailing Address - Street 1:186 PROSSER RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4233
Mailing Address - Country:US
Mailing Address - Phone:931-762-2310
Mailing Address - Fax:931-762-2311
Practice Address - Street 1:186 PROSSER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4233
Practice Address - Country:US
Practice Address - Phone:931-762-2310
Practice Address - Fax:931-762-2311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOODWORKS UNLIMITED LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000018740253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ024461Medicaid