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General NPI Number Information
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NPI Number | 1447903745
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Entity Type | Organization
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Legal Business Name | GOSHEN HOUSE LLC
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 705 SUNSET AVE E
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City | AHOSKIE
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State | NC
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Zip | 27910-3548
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Country | US
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Telephone | 252-398-2558
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Fax | 252-558-0498
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Provider Business Mailing Address
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Address Line | 910 CHURCH ST W
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City | AHOSKIE
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State | NC
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Zip | 27910-2908
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Country | US
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Telephone | 252-398-2558
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Fax | 252-558-0498
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Authorized Official
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Title or Position | OWNER
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Name | LILA P PEELE
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Credential | RN, BSN
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Telephone | 252-398-2556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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