=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538386875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLOSS ENTERPRISE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 512 J W DAVIS DR STE. D
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70403-3992
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-419-2430
-----------------------------------------------------
Fax | 985-419-2431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1814 N MORRISON BLVD STE C&D
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70401-1551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-419-2430
-----------------------------------------------------
Fax | 985-419-2431
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. REGINA GORDON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 985-419-2430
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------