Basic Information
| Provider Information | |||||||||
| NPI: | 1760743231 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOODWILL HOSPICE CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1214 E 33RD ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741052018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188943487 | ||||||||
| FaxNumber: | 9187129880 | ||||||||
| Practice Location | |||||||||
| Address1: | 11230 SORRENTO VALLEY RD | ||||||||
| Address2: | #120 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921211332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586589000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2012 | ||||||||
| LastUpdateDate: | 05/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRUHN | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9188943487 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.