Provider Demographics
NPI:1336888239
Name:GOOD CUSTODIAN SERVICES, LLC
Entity Type:Organization
Organization Name:GOOD CUSTODIAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILOMENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMOND-OGUGUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-589-7866
Mailing Address - Street 1:15426 BEVANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5716
Mailing Address - Country:US
Mailing Address - Phone:571-589-7866
Mailing Address - Fax:
Practice Address - Street 1:15426 BEVANWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5716
Practice Address - Country:US
Practice Address - Phone:571-589-7866
Practice Address - Fax:703-373-2813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD CUSTODIAN SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care