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General NPI Number Information
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NPI Number | 1346616455
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Entity Type | Organization
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Legal Business Name | TIFFANY GOSHATT
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 18570 SAN JOSE BLVD
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-7801
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Country | US
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Telephone | 313-799-6037
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Fax |
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Provider Business Mailing Address
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Address Line | 18570 SAN JOSE BLVD
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-7801
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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 | LPN
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Name | MRS. TIFFANY GOSHATT
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Credential |
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Telephone | 313-799-6037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 4703106260
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License Number State | MI
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