Provider Demographics
NPI:1821594045
Name:GOSHEN FAMILY CLINIC, INC.
Entity Type:Organization
Organization Name:GOSHEN FAMILY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:817-492-1700
Mailing Address - Street 1:6080 S HULEN ST STE 360
Mailing Address - Street 2:PMB 198
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4810
Mailing Address - Country:US
Mailing Address - Phone:817-492-1700
Mailing Address - Fax:
Practice Address - Street 1:6801 MCCART AVE STE 109
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6378
Practice Address - Country:US
Practice Address - Phone:817-492-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center