Provider Demographics
NPI:1619062478
Name:GOYA HEALTH. LTD
Entity Type:Organization
Organization Name:GOYA HEALTH. LTD
Other - Org Name:HERRIN BEHAVIORAL HEALTH. LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CORP. PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:APN,CNS, BC
Authorized Official - Phone:618-988-9843
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:202 S PERSHING
Mailing Address - City:ENERGY
Mailing Address - State:IL
Mailing Address - Zip Code:62933-0100
Mailing Address - Country:US
Mailing Address - Phone:618-988-9843
Mailing Address - Fax:618-942-8640
Practice Address - Street 1:202 SOUTH PERSHING
Practice Address - Street 2:
Practice Address - City:ENERGY
Practice Address - State:IL
Practice Address - Zip Code:62933
Practice Address - Country:US
Practice Address - Phone:618-988-9843
Practice Address - Fax:618-942-8640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-0001152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209110Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL624920Medicare ID - Type Unspecified
P42526Medicare UPIN