Healthcare Provider Details

I. General information

NPI: 1548334980
Provider Name (Legal Business Name): GWIREINC.COM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W OLIVE AVE SUITE B
BURBANK CA
91506-2293
US

IV. Provider business mailing address

1011 W OLIVE AVE SUITE B
BURBANK CA
91506-2293
US

V. Phone/Fax

Practice location:
  • Phone: 818-840-9767
  • Fax: 818-845-3870
Mailing address:
  • Phone: 818-840-9767
  • Fax: 818-845-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberPENDING
License Number StateCA

VIII. Authorized Official

Name: MISS LUISA E. BELLA
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 818-840-9767