Provider Demographics
NPI:1154097194
Name:GOFF MANAGEMENT LLC DBA ORILLA'S WAY
Entity Type:Organization
Organization Name:GOFF MANAGEMENT LLC DBA ORILLA'S WAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LNHA
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-541-2471
Mailing Address - Street 1:18257 LYON ST
Mailing Address - Street 2:
Mailing Address - City:GRANT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64456-8226
Mailing Address - Country:US
Mailing Address - Phone:166-054-1247
Mailing Address - Fax:
Practice Address - Street 1:1209 SOUTH HIGH STREET
Practice Address - Street 2:
Practice Address - City:GRANT CITY
Practice Address - State:MO
Practice Address - Zip Code:64456
Practice Address - Country:US
Practice Address - Phone:660-564-2204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility