MEDICARE: 3G'S DIRECT CARE SERVICES PROVIDER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1063024875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3G'S DIRECT CARE SERVICES PROVIDER LLC

Provider Business Mailing Address
First Line	:	91-692 MAKALEA ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-5944
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-692 MAKALEA ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-5944
Country	:	US
Telephone Number	:	808-683-3867
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GLORIA QUILING RAYMUNDO
Credential	:
Telephone Number	:	808-294-1402

Provider Enumeration Date	:	08/21/2020
Last Update Date	:	08/21/2020

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