Healthcare Provider Details

I. General information

NPI: 1740697812
Provider Name (Legal Business Name): GCC OLNEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 W ELM ST
OLNEY TX
76374-1610
US

IV. Provider business mailing address

1402 W ELM ST
OLNEY TX
76374-1610
US

V. Phone/Fax

Practice location:
  • Phone: 940-564-5631
  • Fax: 940-564-5172
Mailing address:
  • Phone: 940-564-5631
  • Fax: 940-564-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: JAKE HALLSTED
Title or Position: CEO
Credential:
Phone: 832-448-3700