Provider Demographics
NPI:1851842728
Name:GOSHEN VALLEY FOUNDATION
Entity Type:Organization
Organization Name:GOSHEN VALLEY FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-833-1055
Mailing Address - Street 1:387 GOSHEN CHURCH WAY
Mailing Address - Street 2:
Mailing Address - City:WALESKA
Mailing Address - State:GA
Mailing Address - Zip Code:30183
Mailing Address - Country:US
Mailing Address - Phone:770-833-1055
Mailing Address - Fax:866-736-8577
Practice Address - Street 1:387 GOSHEN CHURCH WAY
Practice Address - Street 2:
Practice Address - City:WALESKA
Practice Address - State:GA
Practice Address - Zip Code:30183
Practice Address - Country:US
Practice Address - Phone:770-833-1055
Practice Address - Fax:866-736-8577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005044253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency