MEDICARE: GDC

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	1041C0700X	Clinical Social Worker	1801957774	NE

General Provider Information

NPI Number	:	1124207097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GDC

Provider Business Mailing Address
First Line	:	2505 N 24TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68110-2252
Country	:	US
Telephone Number	:	402-451-5549
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 N 24TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68110-2252
Country	:	US
Telephone Number	:	402-451-5549
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. GAYAL DANETTE CHAMBERS
Credential	:	MHR
Telephone Number	:	402-451-5549

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	10/29/2007

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Directions to “GDC ” Practice Location

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