Individual provider Active NPI

Allyse Brittany Goolsby

  • Home Health Aide
  • Perrysburg, OH
National Provider Identifier
1063073781
Registry record updated Aug 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AideTaxonomy code 374U00000X
Practice address
26757 Lakevue Dr Apt 24
Perrysburg, OH 43551-3304
Phone
(419) 708-1988
NPI assigned
Jun 24, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Aide 374U00000X Primary

Addresses

Primary practice location

26757 Lakevue Dr Apt 24
Perrysburg, OH 43551-3304

Mailing address

PO Box 4466
Toledo, OH 43610-0466
Phone (419) 708-1988

Other identifiers 1

IdentifierTypeStateIssuer
0347867MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1063073781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4466",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436100466",
            "telephone_number": "419-708-1988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26757 LAKEVUE DR APT 24",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435513304",
            "telephone_number": "419-708-1988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOOLSBY",
        "first_name": "ALLYSE",
        "middle_name": "BRITTANY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-24",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0347867",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Perrysburg, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.