Provider Demographics
NPI:1407657216
Name:GBC LOS BANOS LLC
Entity type:Organization
Organization Name:GBC LOS BANOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRYAKOUS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:209-495-7724
Mailing Address - Street 1:5841 N WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-9528
Mailing Address - Country:US
Mailing Address - Phone:209-495-7724
Mailing Address - Fax:
Practice Address - Street 1:135 S CENTER ST
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4507
Practice Address - Country:US
Practice Address - Phone:800-510-1365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS BEHAVIOR CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)