=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790298859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GL&SON LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2017
-----------------------------------------------------
Last Update Date | 02/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8010 SUNRISE BLVD
-----------------------------------------------------
City | CITRUS HEIGHTS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95610-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-786-3860
-----------------------------------------------------
Fax | 916-722-8284
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8010 SUNRISE BLVD
-----------------------------------------------------
City | CITRUS HEIGHTS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95610-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-786-3860
-----------------------------------------------------
Fax | 916-722-8284
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. GODOFREDO PATAWARAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-786-3860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------