Provider Demographics
NPI:1124207097
Name:GDC
Entity type:Organization
Organization Name:GDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAYAL
Authorized Official - Middle Name:DANETTE
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MHR
Authorized Official - Phone:402-451-5549
Mailing Address - Street 1:2505 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-2252
Mailing Address - Country:US
Mailing Address - Phone:402-451-5549
Mailing Address - Fax:
Practice Address - Street 1:2505 N 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-2252
Practice Address - Country:US
Practice Address - Phone:402-451-5549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEAM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18019577741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1801957774Medicare NSC