1255651956 NPI number — GOOD NEIGHBOR HOMES, LLC

Table of content: (NPI 1255651956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255651956 NPI number — GOOD NEIGHBOR HOMES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD NEIGHBOR HOMES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255651956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
313 CONGRESS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02210-1218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-388-5150
Provider Business Mailing Address Fax Number:
617-790-4271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1407 SUMMIT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-520-8005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RODENBERG-ROBERTS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
PATRICIA
Authorized Official Title or Position:
VP & SR. ASST GENERAL COUNSEL
Authorized Official Telephone Number:
952-836-2234

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , with the licence number: 748 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0101497979 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4497 . This is a "DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 748 . This is a "DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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