Healthcare Provider Details

I. General information

NPI: 1023667276
Provider Name (Legal Business Name): GGE ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 MARYLAND AVE
LAS VEGAS NV
89121-4559
US

IV. Provider business mailing address

3970 MARYLAND AVE
LAS VEGAS NV
89121-4559
US

V. Phone/Fax

Practice location:
  • Phone: 702-914-9858
  • Fax:
Mailing address:
  • Phone: 702-914-9858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MARIA CECILIA EMELO
Title or Position: MANAGER
Credential:
Phone: 224-716-1659