1982788568 NPI number — GOODLAND HOME HEALTH,LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982788568 NPI number — GOODLAND HOME HEALTH,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOODLAND HOME HEALTH,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982788568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
516 E. HIGHWAY24
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOODLAND
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67735-0315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-890-7658
Provider Business Mailing Address Fax Number:
785-890-7659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 E. HWY 24
Provider Second Line Business Practice Location Address:
2223 COLLEGE
Provider Business Practice Location Address City Name:
GOODLAND
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67735-0315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-890-7658
Provider Business Practice Location Address Fax Number:
785-890-7659
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCRACKEN
Authorized Official First Name:
WANDA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
OWNER/MANAGING EMPLOYEE
Authorized Official Telephone Number:
785-890-7658

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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