Goshen Health Services LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

GOSHEN HEALTH SERVICES LLC

Doing business as

Dominion Healthcare services L

Practice address

5421 Penn Ave N
Brooklyn Center, MN 55430-2943

Phone

(612) 258-8794

NPI assigned

Nov 19, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yaria Bangura, OWNER

Title

Manager

Phone

(612) 258-8794

Specialties & licenses 1

Addresses

Other names 1

• Dominion Healthcare services L Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693526400000",
    "number": "1073270427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5421 PENN AVE N",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302943",
            "telephone_number": "612-258-8794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5421 PENN AVE N",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302943",
            "telephone_number": "612-258-8794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-19",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A",
        "authorized_official_last_name": "BANGURA",
        "authorized_official_first_name": "YARIA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "612-258-8794",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dominion Healthcare services L",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dominion Healthcare services L",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Brooklyn Center, MN
• Providers in Brooklyn Center, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.