Provider Demographics
NPI:1093290793
Name:GOODWIN, ROLANDA L (LTC ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:ROLANDA
Middle Name:L
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LTC ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-3672
Mailing Address - Country:US
Mailing Address - Phone:803-369-2133
Mailing Address - Fax:
Practice Address - Street 1:2009 SMITH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-3672
Practice Address - Country:US
Practice Address - Phone:803-369-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide