Provider Demographics
NPI:1467048553
Name:GOHEEN, BENJAMIN WULF
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WULF
Last Name:GOHEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29749 N HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-1423
Mailing Address - Country:US
Mailing Address - Phone:304-691-3731
Mailing Address - Fax:
Practice Address - Street 1:29749 N HILLTOP RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-1423
Practice Address - Country:US
Practice Address - Phone:304-691-3731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide