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General NPI Number Information
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NPI Number | 1114678711
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Entity Type | Individual
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Provider Name | GOLD OMOGBEHIN
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Gender | Female
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Dates
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Enumeration Date | 01/14/2022
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 2665 JOHN SMITH RD STE B
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-2623
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Country | US
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Telephone | 910-476-3859
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Fax |
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Provider Business Mailing Address
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Address Line | 1308 SNOWY EGRET DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-3227
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Country | US
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Telephone | 910-476-3859
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2278H0200X
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Taxonomy Name | Home Health Certified Respiratory Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | HC6427
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2279H0200X
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Taxonomy Name | Home Health Registered Respiratory Therapist
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License Number | HC6427
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License Number State | NC
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