Provider Demographics
NPI:1972809911
Name:GOOD HEALTH NUTRITION SERVICES INC
Entity Type:Organization
Organization Name:GOOD HEALTH NUTRITION SERVICES INC
Other - Org Name:GOOD HEALTH INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:IFEOMA
Authorized Official - Last Name:OMERENNAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:301-577-1072
Mailing Address - Street 1:7515 ANNAPOLIS RD STE 402
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1752
Mailing Address - Country:US
Mailing Address - Phone:301-577-1072
Mailing Address - Fax:301-577-1073
Practice Address - Street 1:7515 ANNAPOLIS RD STE 402
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1752
Practice Address - Country:US
Practice Address - Phone:301-577-1072
Practice Address - Fax:301-577-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX 2507302R00000X
MDDX2507305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service