Provider Demographics
NPI:1336764109
Name:GOODWILL HOSPICE SERVICES INC
Entity Type:Organization
Organization Name:GOODWILL HOSPICE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVANMARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-468-3928
Mailing Address - Street 1:22151 VENTURA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1666
Mailing Address - Country:US
Mailing Address - Phone:818-468-3928
Mailing Address - Fax:
Practice Address - Street 1:22151 VENTURA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1666
Practice Address - Country:US
Practice Address - Phone:818-468-3928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based