Provider Demographics
NPI:1215666953
Name:GOWO AFFORDABLE CARE, LLC
Entity type:Organization
Organization Name:GOWO AFFORDABLE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:OOKO
Authorized Official - Last Name:ALUOCH
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:615-618-1992
Mailing Address - Street 1:1994 GALLATIN ROAD N SUITE #304
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115
Mailing Address - Country:US
Mailing Address - Phone:615-618-1992
Mailing Address - Fax:615-239-8363
Practice Address - Street 1:1994 GALLATIN ROAD N SUITE #304
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-618-1992
Practice Address - Fax:615-239-8363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOWO AFFORDABLE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQO57120Medicaid