MEDICARE: GPS PRESCOTT OPCO, 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	283Q00000X	Psychiatric Hospital

General Provider Information

NPI Number	:	1861036386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GPS PRESCOTT OPCO, LLC

Provider Business Mailing Address
First Line	:	181 WHIPPLE ST
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1705
Country	:	US
Telephone Number	:	928-227-3424
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 WHIPPLE ST
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1705
Country	:	US
Telephone Number	:	928-227-3424
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND COO
Name	:	CHRISTY GILBERT
Credential	:
Telephone Number	:	574-277-2630

Provider Enumeration Date	:	10/29/2019
Last Update Date	:	04/29/2021

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