Provider Demographics
NPI:1982327557
Name:GEOFOA LLC
Entity Type:Organization
Organization Name:GEOFOA LLC
Other - Org Name:GOSHEN SPRING HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:OLUMUYIWA
Authorized Official - Last Name:SONOLA-GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-879-4202
Mailing Address - Street 1:3563 FIELDVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-4552
Mailing Address - Country:US
Mailing Address - Phone:469-879-4202
Mailing Address - Fax:469-481-6026
Practice Address - Street 1:3563 FIELDVIEW CT
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-4552
Practice Address - Country:US
Practice Address - Phone:469-879-4202
Practice Address - Fax:469-481-6026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEOFOA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-20
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of Service
No172A00000XOther Service ProvidersDriverGroup - Single Specialty