Provider Demographics
NPI:1770962623
Name:CYNTHIA Y GOODIE
Entity type:Organization
Organization Name:CYNTHIA Y GOODIE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:GOODIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-471-8604
Mailing Address - Street 1:3104 APPLEBLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014
Mailing Address - Country:US
Mailing Address - Phone:469-471-8604
Mailing Address - Fax:
Practice Address - Street 1:3104 APPLE BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2614
Practice Address - Country:US
Practice Address - Phone:469-471-8604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities