Provider Demographics
NPI:1033674551
Name:GFRS LLC
Entity Type:Organization
Organization Name:GFRS LLC
Other - Org Name:AMADA SENIOR CARE OF NORTHWEST INDIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-213-3517
Mailing Address - Street 1:1504 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2375
Mailing Address - Country:US
Mailing Address - Phone:219-213-3517
Mailing Address - Fax:219-213-3513
Practice Address - Street 1:1504 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2375
Practice Address - Country:US
Practice Address - Phone:219-213-3517
Practice Address - Fax:219-213-3513
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GFRS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-08
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AF193OtherLOCATION IDENTIFIER