NPIMap

Organization Active NPI

Goshen Valley Foundation Inc

  • Community/Behavioral Health Agency
  • Canton, GA
National Provider Identifier
1710238787
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
GOSHEN VALLEY FOUNDATION INC
Practice address
230 Marietta Hwy
Canton, GA 30114-2327
Phone
(770) 789-3797
Fax
(404) 937-5580
NPI assigned
Oct 1, 2012
Last updated
Jul 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

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

Authorized official

Name
Mrs. Stacy Leann Sabaka, LPCNPI 1669783247
Title
Executive Director
Phone
(770) 324-1215

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

230 Marietta Hwy
Canton, GA 30114-2327

Mailing address

387 Goshen Church Way
Waleska, GA 30183-2347
Phone (770) 324-1215

Other practice location 1

387 Goshen Church Way
Waleska, GA 30183-2347
Phone (770) 833-1055

Other practice location 2

505 Brown Industrial Pkwy Ste 200
Canton, GA 30114-8013
Phone (770) 789-3797

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240819004215 GA Part B Supplier - Clinic/Group Practice 1254879430 Receives reassigned benefits from 2 practitioners
Practice locations: Canton, GA

National Provider Directory

National Provider Directory
Tax ID family
Goshen Valley Foundation Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

230 Marietta Hwy
Canton, GA 30114
Phone (770) 345-9535

505 Brown Industrial Pkwy
#200
Canton, GA 30114
Phone (770) 789-3797

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721260800000",
    "number": "1710238787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "387 GOSHEN CHURCH WAY",
            "city": "WALESKA",
            "state": "GA",
            "postal_code": "301832347",
            "telephone_number": "770-324-1215",
            "fax_number": "770-796-1954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 MARIETTA HWY",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142327",
            "telephone_number": "770-789-3797",
            "fax_number": "404-937-5580"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "387 Goshen Church Way",
            "address_purpose": "LOCATION",
            "city": "Waleska",
            "state": "GA",
            "postal_code": "301832347",
            "country_code": "US",
            "telephone_number": "770-833-1055",
            "fax_number": "770-796-1954",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "505 Brown Industrial Pkwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "GA",
            "postal_code": "301148013",
            "country_code": "US",
            "telephone_number": "770-789-3797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GOSHEN VALLEY FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-01",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A",
        "authorized_official_last_name": "SABAKA",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "LEANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "770-324-1215",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.