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General NPI Number Information
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NPI Number | 1811874548
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Entity Type | Organization
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Legal Business Name | CITY OF GOSHEN HEALTH SERVICES LLC
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 2828 NW 57TH ST STE 200
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-7070
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Country | US
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Telephone | 240-918-7586
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Fax | 405-938-1422
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Provider Business Mailing Address
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Address Line | 19508 YEARLING WAY
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City | EDMOND
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State | OK
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Zip | 73012-3490
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Country | US
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Telephone | 240-918-7586
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Fax | 405-938-1422
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Authorized Official
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Title or Position | CEO
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Name | MR. RAPHAEL NDAM ADUA
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Credential |
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Telephone | 240-918-7586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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