# GOSHEN DEVELOPMENTAL DISABILITY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Goshen DDC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235910175
- **Authorized official:** MARCEL KALONGA (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (704) 361-9868

## Contact information

- **Practice address:** 617 MORNINGSIDE RD, CHARLOTTE, NC 28214-9105
- **Practice address phone:** (704) 361-9868
- **Mailing address:** 3306 N 190TH PLZ, ELKHORN, NE 68022-3554
- **Mailing address phone:** (402) 252-4497

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 261QA0600X | Adult Day Care Clinic/Center | — | NULL | — |
| 261QD1600X | Developmental Disabilities Clinic/Center | — | NULL | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | — | NULL | — |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 10/06/2023
- **Last updated:** 10/06/2023