Provider Demographics
NPI:1073888061
Name:GERO EXCEL LLC
Entity type:Organization
Organization Name:GERO EXCEL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-445-9069
Mailing Address - Street 1:W156N8327 PILGRIM RD
Mailing Address - Street 2:STE 408
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3776
Mailing Address - Country:US
Mailing Address - Phone:414-395-8106
Mailing Address - Fax:
Practice Address - Street 1:N85W15770 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3043
Practice Address - Country:US
Practice Address - Phone:608-445-9069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care