Provider Demographics
NPI:1063958668
Name:GSM HEALTHCARE SERVICE,LLC
Entity type:Organization
Organization Name:GSM HEALTHCARE SERVICE,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-304-6900
Mailing Address - Street 1:445 S FAIR OAKS AVE STE M10
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2632
Mailing Address - Country:US
Mailing Address - Phone:626-304-6900
Mailing Address - Fax:
Practice Address - Street 1:15125 GALE AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1407
Practice Address - Country:US
Practice Address - Phone:626-330-4048
Practice Address - Fax:626-330-7458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities