Provider Demographics
NPI:1154541944
Name:GOOD HEALTH CARE PROFESSIONALS, INC.
Entity type:Organization
Organization Name:GOOD HEALTH CARE PROFESSIONALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RADDIE
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:580-668-2351
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:OK
Mailing Address - Zip Code:73463-0277
Mailing Address - Country:US
Mailing Address - Phone:580-668-2351
Mailing Address - Fax:580-668-3353
Practice Address - Street 1:182 REDWOOD ST
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:OK
Practice Address - Zip Code:73463-6555
Practice Address - Country:US
Practice Address - Phone:580-668-2351
Practice Address - Fax:580-668-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7015251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377227Medicare ID - Type Unspecified