Healthcare Provider Details

I. General information

NPI: 1801012174
Provider Name (Legal Business Name): GBA HOMECARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 E 195TH UP
EUCLID OH
44117
US

IV. Provider business mailing address

1554 E 195TH UP
EUCLID OH
44117
US

V. Phone/Fax

Practice location:
  • Phone: 216-481-5450
  • Fax:
Mailing address:
  • Phone: 216-481-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberNONE
License Number StateOH

VIII. Authorized Official

Name: MS. BURNICTRICS WEST
Title or Position: MEDICAL ASSISTANT CEO
Credential:
Phone: 216-481-5450