Provider Demographics
NPI:1003094004
Name:ELANT AT GOSHEN, INC.
Entity Type:Organization
Organization Name:ELANT AT GOSHEN, INC.
Other - Org Name:ELANT LICENSED HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-360-1200
Mailing Address - Street 1:46 HARRIMAN DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2410
Mailing Address - Country:US
Mailing Address - Phone:845-360-1200
Mailing Address - Fax:845-291-3833
Practice Address - Street 1:31 CERONE PL
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5104
Practice Address - Country:US
Practice Address - Phone:845-569-0500
Practice Address - Fax:845-569-1887
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELANT AT GOSHEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9470L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01776452Medicaid