Provider Demographics
NPI:1265127021
Name:GOODSTEIN, GRANT SPENCER
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:SPENCER
Last Name:GOODSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7074
Mailing Address - Country:US
Mailing Address - Phone:520-270-0805
Mailing Address - Fax:
Practice Address - Street 1:1911 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7074
Practice Address - Country:US
Practice Address - Phone:520-270-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide