Provider Demographics
NPI:1982788568
Name:GOODLAND HOME HEALTH,LLC
Entity Type:Organization
Organization Name:GOODLAND HOME HEALTH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING EMPLOYEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:785-890-7658
Mailing Address - Street 1:516 E. HIGHWAY24
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-0315
Mailing Address - Country:US
Mailing Address - Phone:785-890-7658
Mailing Address - Fax:785-890-7659
Practice Address - Street 1:516 E. HWY 24
Practice Address - Street 2:2223 COLLEGE
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-0315
Practice Address - Country:US
Practice Address - Phone:785-890-7658
Practice Address - Fax:785-890-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization