Provider Demographics
NPI:1558408575
Name:GOSHEN HOSPITAL ASSOCIATION INC
Entity Type:Organization
Organization Name:GOSHEN HOSPITAL ASSOCIATION INC
Other - Org Name:CARE AT HOME SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:O
Authorized Official - Last Name:DAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-535-2700
Mailing Address - Street 1:1721 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-4723
Mailing Address - Country:US
Mailing Address - Phone:574-535-2700
Mailing Address - Fax:
Practice Address - Street 1:1721 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4723
Practice Address - Country:US
Practice Address - Phone:574-535-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000098260OtherBCBS
IN0613500002Medicare NSC