Provider Demographics
NPI:1215950621
Name:GH MAP INC
Entity type:Organization
Organization Name:GH MAP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-637-1111
Mailing Address - Street 1:1902 B ST
Mailing Address - Street 2:SUITE B G H MAP INC DBA LIFE LINE THERAPY
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301
Mailing Address - Country:US
Mailing Address - Phone:661-637-1111
Mailing Address - Fax:661-637-1112
Practice Address - Street 1:1902 B ST
Practice Address - Street 2:STE B
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3526
Practice Address - Country:US
Practice Address - Phone:661-637-1111
Practice Address - Fax:661-637-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000665261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA054554Medicare ID - Type Unspecified
CA054554Medicare UPIN