MEDICARE: GULF STATES SENIOR SERVICES, INC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1912696139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF STATES SENIOR SERVICES, INC

Provider Business Mailing Address
First Line	:	4466 LOCKHILL SELMA RD STE 101
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2078
Country	:	US
Telephone Number	:	210-614-1132
Fax Number	:	210-614-6399

Provider Business Practice Location Address
First Line	:	4466 LOCKHILL SELMA RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2078
Country	:	US
Telephone Number	:	210-614-1132
Fax Number	:	210-614-6399

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. CHRIS M LERCH
Credential	:
Telephone Number	:	210-614-1132

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	05/03/2023

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