Provider Demographics
NPI:1871877597
Name:GOWIN ENTERPRISES INC
Entity type:Organization
Organization Name:GOWIN ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:GOWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-234-3003
Mailing Address - Street 1:6484 N COUNTY ROAD 1320E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-7952
Mailing Address - Country:US
Mailing Address - Phone:217-345-9415
Mailing Address - Fax:217-345-9415
Practice Address - Street 1:300 LERNA RD S
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9389
Practice Address - Country:US
Practice Address - Phone:217-234-3003
Practice Address - Fax:217-234-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5103061311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)