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General NPI Number Information
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NPI Number | 1790772689
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Entity Type | Organization
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Legal Business Name | GO GO INC
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2200 W UPSHUR AVE
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City | GLADEWATER
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State | TX
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Zip | 75647-4328
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Country | US
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Telephone | 903-845-2181
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Fax | 903-845-3704
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Provider Business Mailing Address
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Address Line | PO BOX 1468
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City | GLADEWATER
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State | TX
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Zip | 75647-1468
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Country | US
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Telephone | 903-845-2181
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Fax | 903-845-3704
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Authorized Official
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Title or Position | MDS/CARE PLAN COORDINATOR
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Name | MRS. MARY T. MINOR
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Credential | LVN
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Telephone | 903-845-2181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number |
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License Number State | TX
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