Goforth Residential Services LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

GOFORTH RESIDENTIAL SERVICES LLC

Practice address

2413 Prophetstown Rd
Avon, IN 46123-5921

Phone

(518) 269-8299

NPI assigned

Apr 16, 2024

Organization subpart

No

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

Authorized official

Name

Jeanne Sinzinkayo

Title

Manager

Phone

(518) 269-8299

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1713225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1447004262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2413 PROPHETSTOWN RD",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461235921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2413 PROPHETSTOWN RD",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461235921",
            "telephone_number": "518-269-8299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOFORTH RESIDENTIAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-16",
        "last_updated": "2024-04-16",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "SINZINKAYO",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "518-269-8299"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2024; 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.