Healthcare Provider Details

I. General information

NPI: 1699197830
Provider Name (Legal Business Name): GSDED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S 1300 E SUITE C
SALT LAKE CITY UT
84105-3654
US

IV. Provider business mailing address

2020 S 1300 E SUITE C
SALT LAKE CITY UT
84105-3654
US

V. Phone/Fax

Practice location:
  • Phone: 801-401-3515
  • Fax: 801-401-3503
Mailing address:
  • Phone: 801-401-3515
  • Fax: 801-401-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HAWKINS
Title or Position: MEMBER
Credential:
Phone: 801-401-3515