Provider Demographics
NPI:1073000469
Name:GOODMAN ADDICTION SERVICES
Entity type:Organization
Organization Name:GOODMAN ADDICTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAC/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:PADILLA
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC
Authorized Official - Phone:701-833-5767
Mailing Address - Street 1:1809 SOUTH BROADWAY SUITE. S
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701
Mailing Address - Country:US
Mailing Address - Phone:701-852-3869
Mailing Address - Fax:701-852-9024
Practice Address - Street 1:1809 SOUTH BROADWAY SUITE S.
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701
Practice Address - Country:US
Practice Address - Phone:701-852-3869
Practice Address - Fax:701-852-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1400101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty