Organization
ON THE GO MEDICAL STAFFING AND EDUCATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MARY KATHLEEN GOODE (PARTNER/NURSE INSTRUCTOR)
(571) 268-9366
Entity
Organization
Contact information
Practice address
555 GROVE ST STE 100, HERNDON, VA 20170-4728
(571) 707-9812
Mailing address
14579 GOLDEN OAK RD, CENTREVILLE, VA 20121-2261
(571) 268-9366
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
0001197288
VA
251J00000X
Nursing Care Agency
Primary
0001197288
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001197288
VIRGINIA NURSING LICENSE NUMBER
VA
Enumeration date
03/19/2012
Last updated
10/26/2020
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