# GOFAN HEALTHCARE SERVICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346058328
- **Authorized official:** JACINTA MADU (OWNER)
- **Authorized official phone:** (804) 469-0044

## Contact information

- **Practice address:** 6200 BALTIMORE AVE STE 300, RIVERDALE, MD 20737-1054
- **Practice address phone:** (469) 296-8177
- **Practice address fax:** (469) 722-5748
- **Mailing address:** 2072 ROYAL ACRES TRL, FRISCO, TX 75036-8772
- **Mailing address phone:** (469) 296-8177
- **Mailing address fax:** (972) 435-4426

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/23/2024
- **Last updated:** 12/23/2024