Organization
GODS SPEED HOME HEALTHCARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHANIEL JACKSON (OWNER)
(757) 536-0080
Entity
Organization
Contact information
Practice address
425 W WASHINGTON ST STE 213, SUFFOLK, VA 23434-5320
(757) 536-0080
(757) 925-4791
Mailing address
309 FESTIVAL CT, SUFFOLK, VA 23434-9255
(757) 536-0080
(757) 925-4791
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T61-53-1483
DRIVER'S LICENSE
VA
Enumeration date
01/14/2019
Last updated
01/30/2019
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