Healthcare Provider Details

I. General information

NPI: 1124711619
Provider Name (Legal Business Name): GOODLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 N 4200 RD
HUGO OK
74743-8510
US

IV. Provider business mailing address

1216 N 4200 RD
HUGO OK
74743-8510
US

V. Phone/Fax

Practice location:
  • Phone: 580-326-7568
  • Fax:
Mailing address:
  • Phone: 580-326-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRIS SCOTT
Title or Position: CEO
Credential:
Phone: 580-326-7568