Healthcare Provider Details

I. General information

NPI: 1376139527
Provider Name (Legal Business Name): GOSHEN TOTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 S 12TH ST
ALLENTOWN PA
18103-3816
US

IV. Provider business mailing address

1013 S 12TH ST
ALLENTOWN PA
18103-3816
US

V. Phone/Fax

Practice location:
  • Phone: 484-656-1737
  • Fax:
Mailing address:
  • Phone: 484-656-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JENIFFET OLOUGHLIN
Title or Position: CEO
Credential:
Phone: 484-656-1737