1760743231 NPI number — GOODWILL HOSPICE CARE INC

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 1760743231 NPI number — GOODWILL HOSPICE CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOODWILL HOSPICE CARE INC
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:
1760743231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1214 E 33RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74105-2018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-894-3487
Provider Business Mailing Address Fax Number:
918-712-9880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11230 SORRENTO VALLEY RD
Provider Second Line Business Practice Location Address:
#120
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-658-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRUHN
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
918-894-3487

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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