Provider Demographics
NPI:1477673705
Name:THE HOUSE OF GOSHEN
Entity Type:Organization
Organization Name:THE HOUSE OF GOSHEN
Other - Org Name:THE HOUSE OF GOHEN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-834-6152
Mailing Address - Street 1:5403 13TH ST NW
Mailing Address - Street 2:1220 12TH ST. NW STE. 513
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3609
Mailing Address - Country:US
Mailing Address - Phone:202-834-6152
Mailing Address - Fax:202-842-0174
Practice Address - Street 1:5403 13TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3609
Practice Address - Country:US
Practice Address - Phone:202-834-6152
Practice Address - Fax:202-842-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center