Provider Demographics
NPI:1699383232
Name:GOODWILL HEALTHCARE SERVICES INC.
Entity Type:Organization
Organization Name:GOODWILL HEALTHCARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVRANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-227-5100
Mailing Address - Street 1:6906 MIRAMAR RD STE C, # 144
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121
Mailing Address - Country:US
Mailing Address - Phone:747-227-5100
Mailing Address - Fax:747-279-4219
Practice Address - Street 1:8380 MIRAMAR MALL STE 225B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2550
Practice Address - Country:US
Practice Address - Phone:747-227-5100
Practice Address - Fax:747-279-4219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based