Goshen Developmental Disability Center

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

GOSHEN DEVELOPMENTAL DISABILITY CENTER

Practice address

617 Morningside Rd
Charlotte, NC 28214-9105

Phone

(704) 361-9868

NPI assigned

Oct 6, 2023

Organization subpart

No

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

Authorized official

Name

Marcel Kalonga

Title

Executive Director

Phone

(704) 361-9868

Specialties & licenses 6

Addresses

Other names 1

• Goshen DDC Doing business as

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

{
    "created_epoch": "1696550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1235910175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3306 N 190TH PLZ",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680223554",
            "telephone_number": "402-252-4497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 MORNINGSIDE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282149105",
            "telephone_number": "704-361-9868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN DEVELOPMENTAL DISABILITY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-06",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A",
        "authorized_official_last_name": "KALONGA",
        "authorized_official_first_name": "MARCEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-361-9868"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goshen DDC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Yezzi Gorman, CRNA
• Wendy P Gorman, PT
• Joan Novak Gormley, MSP, CCC-SLP
• Madison Gorniak
• Sashivani Gosala, MD
• Jordan Lynn Gosik
• Junius Blake Goslen III, M.D.
• Hailey Louise Gosnell, MD
• Lauren Gosnell
• Mackenzie Leigh Gosnell, PA-C

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.