Provider Demographics
NPI:1134311129
Name:GO ENTERPRISES, INC.
Entity Type:Organization
Organization Name:GO ENTERPRISES, INC.
Other - Org Name:DBA INCONTINENT SOLUTIONS NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:OTTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-859-8493
Mailing Address - Street 1:26044 119TH DR SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-8405
Mailing Address - Country:US
Mailing Address - Phone:253-859-8493
Mailing Address - Fax:253-859-8493
Practice Address - Street 1:26044 119TH DR SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-8405
Practice Address - Country:US
Practice Address - Phone:253-859-8493
Practice Address - Fax:253-859-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9054503Medicaid