Healthcare Provider Details

I. General information

NPI: 1861210031
Provider Name (Legal Business Name): GALAXY LUCIANO GOMEZ HHA, PCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EGGERT ST
TURTLE LAKE ND
58575-4027
US

IV. Provider business mailing address

PO BOX 94
TURTLE LAKE ND
58575-0094
US

V. Phone/Fax

Practice location:
  • Phone: 406-396-8747
  • Fax:
Mailing address:
  • Phone: 406-396-8747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number510365
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: