Healthcare Provider Details

I. General information

NPI: 1750545323
Provider Name (Legal Business Name): GBA WEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 WALNUT ST
COLORADO CITY TX
79512-6318
US

IV. Provider business mailing address

6330 SPRINT PKWY STE 300
OVERLAND PARK KS
66211-1157
US

V. Phone/Fax

Practice location:
  • Phone: 325-728-2657
  • Fax: 325-728-3527
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number012263
License Number StateTX

VIII. Authorized Official

Name: JOHN NICHOLS
Title or Position: AUTHORZIED OFFICIAL
Credential:
Phone: 325-728-2657