Provider Demographics
NPI:1700499944
Name:GOAL DIGGER NETWORK LLC
Entity type:Organization
Organization Name:GOAL DIGGER NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:TAHIA
Authorized Official - Last Name:MCKOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-527-9667
Mailing Address - Street 1:5220 DELCO ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-2332
Mailing Address - Country:US
Mailing Address - Phone:910-527-9667
Mailing Address - Fax:
Practice Address - Street 1:5220 DELCO ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-2332
Practice Address - Country:US
Practice Address - Phone:910-527-9667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management