1134238306 NPI number — GOOD FRIENDS SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134238306 NPI number — GOOD FRIENDS SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD FRIENDS SERVICES, INC.
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:
1134238306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9500 NW 77TH AVE
Provider Second Line Business Mailing Address:
SUITE 28
Provider Business Mailing Address City Name:
HIALEAH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33016-2530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-522-2346
Provider Business Mailing Address Fax Number:
786-522-2347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9500 NW 77TH AVE
Provider Second Line Business Practice Location Address:
SUITE 28
Provider Business Practice Location Address City Name:
HIALEAH GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33016-2530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-522-2346
Provider Business Practice Location Address Fax Number:
786-522-2347
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAO
Authorized Official First Name:
IGNACIO
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
786-522-2346

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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