Provider Demographics
NPI:1154001139
Name:GOODWILL HOMES LLC
Entity type:Organization
Organization Name:GOODWILL HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEYOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-258-3344
Mailing Address - Street 1:13126 MERCURY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3711
Mailing Address - Country:US
Mailing Address - Phone:202-258-3344
Mailing Address - Fax:
Practice Address - Street 1:13126 MERCURY LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3711
Practice Address - Country:US
Practice Address - Phone:202-258-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child