Provider Demographics
NPI:1063783587
Name:GOODHOPE HEALTH SERVICES INC.
Entity type:Organization
Organization Name:GOODHOPE HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KISOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-920-0782
Mailing Address - Street 1:914 SILVER SPRING AVE
Mailing Address - Street 2:112
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4621
Mailing Address - Country:US
Mailing Address - Phone:301-920-0782
Mailing Address - Fax:301-588-5029
Practice Address - Street 1:914 SILVER SPRING AVE
Practice Address - Street 2:112
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4621
Practice Address - Country:US
Practice Address - Phone:301-920-0782
Practice Address - Fax:301-588-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3105251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health