Provider Demographics
NPI:1124012836
Name:GOODHOPE HOMECARE INC.
Entity Type:Organization
Organization Name:GOODHOPE HOMECARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EFFIONG
Authorized Official - Middle Name:SUNDAY
Authorized Official - Last Name:IMOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-565-0583
Mailing Address - Street 1:13437 HWY 110 S
Mailing Address - Street 2:STE 1
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-6374
Mailing Address - Country:US
Mailing Address - Phone:903-565-0583
Mailing Address - Fax:903-565-0583
Practice Address - Street 1:13437 HWY 110 S
Practice Address - Street 2:STE 1
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-6374
Practice Address - Country:US
Practice Address - Phone:903-565-0583
Practice Address - Fax:903-565-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0068078332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4825860002Medicare NSC