MEDICARE: GBAC, 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1649863457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GBAC, LLC

Provider Business Mailing Address
First Line	:	322 RESERVOIR ST
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 RESERVOIR ST
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3169
Country	:	US
Telephone Number	:	617-504-2304
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RYAN CAULFIELD
Credential	:
Telephone Number	:	617-504-2304

Provider Enumeration Date	:	02/12/2021
Last Update Date	:	02/12/2021

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Directions to “GBAC, LLC ” Practice Location

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