Healthcare Provider Details

I. General information

NPI: 1962229559
Provider Name (Legal Business Name): GSHA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24225 W 9 MILE RD SUITE 140-1163
SOUTHFIELD MI
48033
US

IV. Provider business mailing address

2901 E GREENWAY RD
PHOENIX AZ
85032-9998
US

V. Phone/Fax

Practice location:
  • Phone: 866-377-4742
  • Fax:
Mailing address:
  • Phone: 866-377-4742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ONDRANIQUE EDISON
Title or Position: MEMBER
Credential:
Phone: 866-377-4742