MEDICARE: GAY SENIOR SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1457696874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAY SENIOR SERVICES LLC

Provider Business Mailing Address
First Line	:	1284 HAVENHURST DR
Second Line	:	#104
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-4956
Country	:	US
Telephone Number	:	323-380-7952
Fax Number	:

Provider Business Practice Location Address
First Line	:	1284 HAVENHURST DR
Second Line	:	#104
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-4956
Country	:	US
Telephone Number	:	323-380-7952
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRAD A WEISSBERG
Credential	:
Telephone Number	:	323-380-7952

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	12/19/2012

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