Provider Demographics
NPI:1316478233
Name:GOOD 2B HOME, LLC
Entity type:Organization
Organization Name:GOOD 2B HOME, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REANNA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:402-541-5237
Mailing Address - Street 1:6047 TYVOLA GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-6431
Mailing Address - Country:US
Mailing Address - Phone:980-288-4103
Mailing Address - Fax:980-206-0258
Practice Address - Street 1:5331 N 36TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-1563
Practice Address - Country:US
Practice Address - Phone:402-541-5237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251E00000X
KS251E00000X
NE73227251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health