MEDICARE: GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	251B00000X	Case Management Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	273R00000X	Psychiatric Hospital Unit	GU
4	273R00000X	Psychiatric Hospital Unit
5	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1619928264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION

Provider Business Mailing Address
First Line	:	790 GOVERNOR CARLOS G. CAMACHO ROAD
Second Line	:
City	:	TAMUNING
State	:	GU
Zip	:	96913
Country	:	US
Telephone Number	:	671-647-1901
Fax Number	:	671-649-6948

Provider Business Practice Location Address
First Line	:	790 GOVERNOR CARLOS G. CAMACHO ROAD
Second Line	:
City	:	TAMUNING
State	:	GU
Zip	:	96913
Country	:	US
Telephone Number	:	671-647-1901
Fax Number	:	671-649-6948

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CARISSA E PANGELINAN
Credential	:
Telephone Number	:	671-647-1901

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	01/25/2026

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