Provider Demographics
NPI:1215690557
Name:G2M4 LLC
Entity type:Organization
Organization Name:G2M4 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK ANTHONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-593-8262
Mailing Address - Street 1:549 NW LAKE WHITNEY PL STE 106
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1606
Mailing Address - Country:US
Mailing Address - Phone:772-924-3210
Mailing Address - Fax:772-924-3210
Practice Address - Street 1:549 NW LAKE WHITNEY PL STE 106
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1606
Practice Address - Country:US
Practice Address - Phone:772-924-3210
Practice Address - Fax:772-924-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care