Provider Demographics
NPI:1588927438
Name:GO HEALTHCARE, INC.
Entity type:Organization
Organization Name:GO HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:V
Authorized Official - Last Name:STANSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-346-4698
Mailing Address - Street 1:72880 FRED WARING DR
Mailing Address - Street 2:SUITE D18
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-9373
Mailing Address - Country:US
Mailing Address - Phone:760-346-4698
Mailing Address - Fax:760-346-5784
Practice Address - Street 1:72880 FRED WARING DR
Practice Address - Street 2:SUITE D18
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9373
Practice Address - Country:US
Practice Address - Phone:760-346-4698
Practice Address - Fax:760-346-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6703460001Medicare NSC
CAGH197AMedicare PIN