Provider Demographics
NPI:1114030939
Name:GOSHEN HOSPITAL ASSOCIATION, INC.
Entity Type:Organization
Organization Name:GOSHEN HOSPITAL ASSOCIATION, INC.
Other - Org Name:CARE AT HOME SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:O
Authorized Official - Last Name:DAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-533-2141
Mailing Address - Street 1:1721 S MAIN ST
Mailing Address - Street 2:IDENTIFIERS
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-4723
Mailing Address - Country:US
Mailing Address - Phone:574-533-2141
Mailing Address - Fax:
Practice Address - Street 1:200 HIGH PARK AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4810
Practice Address - Country:US
Practice Address - Phone:574-535-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOSHEN HOSPITAL ASSOCIATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-16
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000098260OtherBCBS
IN000000098260OtherBCBS