Provider Demographics
NPI:1588713739
Name:GOSHEN HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:GOSHEN HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOENEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-664-0945
Mailing Address - Street 1:1255 W 15TH ST STE 900
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4214
Mailing Address - Country:US
Mailing Address - Phone:972-664-0945
Mailing Address - Fax:972-664-0139
Practice Address - Street 1:1255 W 15TH ST STE 900
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4214
Practice Address - Country:US
Practice Address - Phone:972-664-0945
Practice Address - Fax:972-664-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251F00000X, 251J00000X, 253Z00000X, 374U00000X, 385H00000X
TX010216251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202114901Medicaid