Provider Demographics
NPI:1295476042
Name:GOSHEN HOMECARE SERVICES LLC
Entity type:Organization
Organization Name:GOSHEN HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES/ADMIN/DIR OF CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:SCHOLARSTICAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-332-1543
Mailing Address - Street 1:30848 9TH PL S APT A201
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-9022
Mailing Address - Country:US
Mailing Address - Phone:480-332-1543
Mailing Address - Fax:
Practice Address - Street 1:30848 9TH PL S APT A201
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-9022
Practice Address - Country:US
Practice Address - Phone:480-332-1543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care