=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336150176
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GM HEALTHCARE PROVIDERS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 07/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6254 SW 8TH ST SUIT 6
-----------------------------------------------------
City | WEST MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-261-3849
-----------------------------------------------------
Fax | 305-261-6583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6254 SW 8TH ST SUIT 6
-----------------------------------------------------
City | WEST MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-261-3849
-----------------------------------------------------
Fax | 305-261-6583
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE ASSISTANT
-----------------------------------------------------
Name | ALEXANDER SASTRI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-261-3849
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------