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General NPI Number Information
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NPI Number | 1013454644
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Entity Type | Organization
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Legal Business Name | GSM HEALTHCARE SERVICE, LLC
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 15122 WALBROOK DR
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-1430
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Country | US
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Telephone | 626-330-4048
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Fax | 626-330-7458
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Provider Business Mailing Address
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Address Line | 445 S FAIR OAKS AVE
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City | PASADENA
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State | CA
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Zip | 91105-2632
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Country | US
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Telephone | 626-304-6900
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. GRACE S MERCADO
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Credential |
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Telephone | 626-304-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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