Healthcare Provider Details

I. General information

NPI: 1598329518
Provider Name (Legal Business Name): GERAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23403 E MISSION AVE STE 150
LIBERTY LAKE WA
99019-7554
US

IV. Provider business mailing address

PO BOX 130
LIBERTY LAKE WA
99019-0130
US

V. Phone/Fax

Practice location:
  • Phone: 509-795-5501
  • Fax: 509-755-4974
Mailing address:
  • Phone: 509-755-4944
  • Fax: 509-755-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: JASON WIBERG
Title or Position: CFO
Credential:
Phone: 509-755-4944