Provider Demographics
NPI:1609196484
Name:GOSHEN HOME HEALTH SERVICES INC
Entity Type:Organization
Organization Name:GOSHEN HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNDOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-600-9712
Mailing Address - Street 1:P.O. BOX 16221
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75016-7221
Mailing Address - Country:US
Mailing Address - Phone:972-600-9712
Mailing Address - Fax:972-600-9757
Practice Address - Street 1:1000 N BELT LINE RD
Practice Address - Street 2:STE 203
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-4069
Practice Address - Country:US
Practice Address - Phone:972-600-9712
Practice Address - Fax:972-600-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health