Healthcare Provider Details

I. General information

NPI: 1740707553
Provider Name (Legal Business Name): GURU HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W MICKEY MANTLE PATH
HERNANDO FL
34442-5190
US

IV. Provider business mailing address

6752 W GULF TO LAKE HWY STE 204
CRYSTAL RIVER FL
34429-9348
US

V. Phone/Fax

Practice location:
  • Phone: 929-374-4268
  • Fax:
Mailing address:
  • Phone: 929-374-4268
  • Fax: 929-214-4268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRIS GRANT
Title or Position: PRESIDENT
Credential:
Phone: 352-566-2751