MEDICARE: GBLONG 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	:	1922357052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GBLONG LLC

Provider Business Mailing Address
First Line	:	18438 AUSTIN OAK LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2276
Country	:	US
Telephone Number	:	281-762-0499
Fax Number	:	281-762-0499

Provider Business Practice Location Address
First Line	:	18438 AUSTIN OAK LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2276
Country	:	US
Telephone Number	:	281-762-0499
Fax Number	:	281-762-0499

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. OLUWAGBEMIGA OLANIYI LONGE
Credential	:
Telephone Number	:	281-627-5680

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	09/05/2012

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Directions to “GBLONG LLC ” Practice Location

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