Organization
GOFORTH INSPIRED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P GOFORTH (EXECUTIVE DIRECTOR)
(503) 857-0394
Entity
Organization
Contact information
Practice address
345 NE BAKER CREEK RD, MCMINNVILLE, OR 97128-2019
(971) 241-9275
Mailing address
PO BOX 1171, MCMINNVILLE, OR 97128-1171
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
09/06/2013
Last updated
12/02/2016
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