Provider Demographics
NPI:1538584271
Name:GOODWATER, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:GOODWATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 GRADDICK RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3343
Mailing Address - Country:US
Mailing Address - Phone:843-324-0311
Mailing Address - Fax:
Practice Address - Street 1:1240 WINNOWING WAY STE 102
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7523
Practice Address - Country:US
Practice Address - Phone:843-324-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion