Provider Demographics
NPI:1306285168
Name:GOODHEAVEN AFCH, INC
Entity type:Organization
Organization Name:GOODHEAVEN AFCH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:772-646-1939
Mailing Address - Street 1:124 BELLAMY TRL
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-6483
Mailing Address - Country:US
Mailing Address - Phone:772-646-1939
Mailing Address - Fax:772-589-7328
Practice Address - Street 1:124 BELLAMY TRL
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-6483
Practice Address - Country:US
Practice Address - Phone:772-646-1939
Practice Address - Fax:772-589-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906452251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care