Provider Demographics
NPI:1801575667
Name:LAND OF GOODS LLC
Entity type:Organization
Organization Name:LAND OF GOODS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CRC, CVE, IPEC, CLCP
Authorized Official - Phone:386-355-1140
Mailing Address - Street 1:627 N GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-3806
Mailing Address - Country:US
Mailing Address - Phone:386-355-1110
Mailing Address - Fax:386-355-1141
Practice Address - Street 1:627 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-3806
Practice Address - Country:US
Practice Address - Phone:386-355-1110
Practice Address - Fax:386-355-1141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAND OF GOODS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty