Healthcare Provider Details

I. General information

NPI: 1215950621
Provider Name (Legal Business Name): GH MAP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 B ST STE B
BAKERSFIELD CA
93301-3526
US

IV. Provider business mailing address

1902 B ST SUITE B G H MAP INC DBA LIFE LINE THERAPY
BAKERSFIELD CA
93301
US

V. Phone/Fax

Practice location:
  • Phone: 661-637-1111
  • Fax: 661-637-1112
Mailing address:
  • Phone: 661-637-1111
  • Fax: 661-637-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number120000665
License Number StateCA

VIII. Authorized Official

Name: MELISSA ANN CHANG
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 661-637-1111