Provider Demographics
NPI:1326921180
Name:GOGA, RETA
Entity type:Individual
Prefix:
First Name:RETA
Middle Name:
Last Name:GOGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13420 AMBERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3149
Mailing Address - Country:US
Mailing Address - Phone:586-707-1014
Mailing Address - Fax:586-707-1014
Practice Address - Street 1:13420 AMBERGLEN DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3149
Practice Address - Country:US
Practice Address - Phone:586-707-1014
Practice Address - Fax:586-707-1014
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
393356135OtherHOME CARE AGENCY