Provider Demographics
NPI:1811874548
Name:CITY OF GOSHEN HEALTH SERVICES LLC
Entity type:Organization
Organization Name:CITY OF GOSHEN HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:NDAM
Authorized Official - Last Name:ADUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-918-7586
Mailing Address - Street 1:19508 YEARLING WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-3490
Mailing Address - Country:US
Mailing Address - Phone:240-918-7586
Mailing Address - Fax:405-938-1422
Practice Address - Street 1:2828 NW 57TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7070
Practice Address - Country:US
Practice Address - Phone:240-918-7586
Practice Address - Fax:405-938-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No385H00000XRespite Care FacilityRespite Care