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General NPI Number Information
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NPI Number | 1194150326
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Entity Type | Organization
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Legal Business Name | GOFORTH INSPIRED LLC
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 345 NE BAKER CREEK RD
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City | MCMINNVILLE
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State | OR
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Zip | 97128-2019
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Country | US
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Telephone | 971-241-9275
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1171
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City | MCMINNVILLE
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State | OR
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Zip | 97128-1171
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOHN P GOFORTH
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Credential |
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Telephone | 503-857-0394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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