Provider Demographics
NPI:1679262596
Name:GOSHEN GROUP HOME LLC
Entity Type:Organization
Organization Name:GOSHEN GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUWATOYIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-370-1949
Mailing Address - Street 1:4478 STOLE RD
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-5222
Mailing Address - Country:US
Mailing Address - Phone:215-370-1949
Mailing Address - Fax:
Practice Address - Street 1:100 RAMAPO TRL APT A7
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-8587
Practice Address - Country:US
Practice Address - Phone:215-370-1949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities