Provider Demographics
NPI:1679024913
Name:GOSHENI LLC
Entity Type:Organization
Organization Name:GOSHENI LLC
Other - Org Name:GOSHENI HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:OLOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-221-7553
Mailing Address - Street 1:605 AVIS DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2283
Mailing Address - Country:US
Mailing Address - Phone:301-232-7685
Mailing Address - Fax:301-324-0897
Practice Address - Street 1:605 AVIS DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2283
Practice Address - Country:US
Practice Address - Phone:301-232-7685
Practice Address - Fax:301-324-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHCSA9912127261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service