Provider Demographics
NPI:1447903745
Name:GOSHEN HOUSE LLC
Entity type:Organization
Organization Name:GOSHEN HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILA
Authorized Official - Middle Name:P
Authorized Official - Last Name:PEELE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:252-398-2556
Mailing Address - Street 1:910 CHURCH ST W
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-2908
Mailing Address - Country:US
Mailing Address - Phone:252-398-2558
Mailing Address - Fax:252-558-0498
Practice Address - Street 1:705 SUNSET AVE E
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3548
Practice Address - Country:US
Practice Address - Phone:252-398-2558
Practice Address - Fax:252-558-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child