Provider Demographics
NPI:1477328623
Name:GO DEHP LLC
Entity Type:Organization
Organization Name:GO DEHP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-225-0555
Mailing Address - Street 1:3800 N CENTRAL AVE FL 17
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1992
Mailing Address - Country:US
Mailing Address - Phone:480-225-0555
Mailing Address - Fax:
Practice Address - Street 1:3800 N CENTRAL AVE FL 17
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1992
Practice Address - Country:US
Practice Address - Phone:480-225-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GO DEHP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty