Healthcare Provider Details

I. General information

NPI: 1245161033
Provider Name (Legal Business Name): GOREALA ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24415 40TH AVE E
SPANAWAY WA
98387-7008
US

IV. Provider business mailing address

24415 40TH AVE E
SPANAWAY WA
98387-7008
US

V. Phone/Fax

Practice location:
  • Phone: 253-306-9155
  • Fax:
Mailing address:
  • Phone: 253-306-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATRINA PEROVIC
Title or Position: SECRETARY
Credential:
Phone: 253-306-9155