Healthcare Provider Details

I. General information

NPI: 1164488979
Provider Name (Legal Business Name): GBA HOLDING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 TEXAS AVE
LUBBOCK TX
79401-4034
US

IV. Provider business mailing address

12900 FOSTER ST SUITE 400
OVERLAND PARK KS
66213-2704
US

V. Phone/Fax

Practice location:
  • Phone: 806-472-6900
  • Fax: 806-788-5571
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number011445
License Number StateTX

VIII. Authorized Official

Name: RUTH SCHWARTZ
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 913-814-2288