MEDICARE: GBA WEST, 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	012263	TX

General Provider Information

NPI Number	:	1750545323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GBA WEST, LLC

Provider Business Mailing Address
First Line	:	6330 SPRINT PKWY STE 300
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	271 WALNUT ST
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-6318
Country	:	US
Telephone Number	:	325-728-2657
Fax Number	:	325-728-3527

Authorized Official
Title or Position	:	AUTHORZIED OFFICIAL
Name	:	JOHN NICHOLS
Credential	:
Telephone Number	:	325-728-2657

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	11/30/2023

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Directions to “GBA WEST, LLC ” Practice Location

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