Provider Demographics
NPI:1134580434
Name:GOSHEN TRANSPORTATION SERVICE/ELOHIMS CONNECTIONS
Entity type:Organization
Organization Name:GOSHEN TRANSPORTATION SERVICE/ELOHIMS CONNECTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NON-EMERGENCY TRANSPORT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-336-3057
Mailing Address - Street 1:P.O. BOX 19334
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1614
Mailing Address - Country:US
Mailing Address - Phone:216-336-3057
Mailing Address - Fax:
Practice Address - Street 1:19200 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1614
Practice Address - Country:US
Practice Address - Phone:216-336-3057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport