Provider Demographics
NPI:1477361319
Name:GOSHEN HOME CARE LLC
Entity type:Organization
Organization Name:GOSHEN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BENEDICTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-933-1532
Mailing Address - Street 1:12050 ZANJERO RD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2694
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12050 ZANJERO RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2694
Practice Address - Country:US
Practice Address - Phone:404-933-1532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health