Healthcare Provider Details

I. General information

NPI: 1164668059
Provider Name (Legal Business Name): GOS OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 01/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151A KNOLLWOOD DR
MOBILE AL
36693-2745
US

IV. Provider business mailing address

3151A KNOLLWOOD DR
MOBILE AL
36693-2745
US

V. Phone/Fax

Practice location:
  • Phone: 251-661-7608
  • Fax: 251-602-9146
Mailing address:
  • Phone: 251-661-7608
  • Fax: 251-602-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5527 (SCALF)
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5525 (NH)
License Number StateAL

VIII. Authorized Official

Name: GERALD B. MCAULIFFE
Title or Position: ADMINISTRATOR
Credential:
Phone: 251-661-7608