Healthcare Provider Details

I. General information

NPI: 1205358694
Provider Name (Legal Business Name): GPCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL DR
BORGER TX
79007-7579
US

IV. Provider business mailing address

100 MEDICAL DR
BORGER TX
79007-7579
US

V. Phone/Fax

Practice location:
  • Phone: 806-467-5707
  • Fax: 806-467-5726
Mailing address:
  • Phone: 806-467-5707
  • Fax: 806-467-5726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS MELODY HENDERSON
Title or Position: INTERIM CEO
Credential:
Phone: 806-467-5700