Provider Demographics
NPI:1215826060
Name:GOSHEN DDC
Entity type:Organization
Organization Name:GOSHEN DDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT SUPORT PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:JUSTICE
Authorized Official - Middle Name:
Authorized Official - Last Name:USENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-510-5973
Mailing Address - Street 1:3708 N 106TH PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-3404
Mailing Address - Country:US
Mailing Address - Phone:402-510-5973
Mailing Address - Fax:404-025-1059
Practice Address - Street 1:3306 N 190TH PLZ
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3554
Practice Address - Country:US
Practice Address - Phone:140-225-2449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services