Provider Demographics
NPI:1568582468
Name:GOOD JOURNEY HOME HEALTH, LLC
Entity Type:Organization
Organization Name:GOOD JOURNEY HOME HEALTH, LLC
Other - Org Name:GOOD JOURNEY HOME HEALTH AND HOSPICE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:405-482-8965
Mailing Address - Street 1:36 NE 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1826
Mailing Address - Country:US
Mailing Address - Phone:405-482-8965
Mailing Address - Fax:405-456-6800
Practice Address - Street 1:36 NE 52ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-1826
Practice Address - Country:US
Practice Address - Phone:405-482-8965
Practice Address - Fax:405-482-8965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7811251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377697Medicare ID - Type UnspecifiedHOME HEALTH AGENCY
OK371660Medicare ID - Type UnspecifiedHOSPICE