Provider Demographics
NPI:1063506061
Name:GB FAMILY HEALTHCARE, INC
Entity Type:Organization
Organization Name:GB FAMILY HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CASIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-899-7884
Mailing Address - Street 1:PO BOX 644
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-0644
Mailing Address - Country:US
Mailing Address - Phone:787-899-7884
Mailing Address - Fax:787-899-7884
Practice Address - Street 1:CALLE AMISTAD #8
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-0000
Practice Address - Country:US
Practice Address - Phone:787-899-7884
Practice Address - Fax:787-899-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRAPM-328332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRAGENCY #7OtherMCS CLASSICARE
PR50206OtherPREFFERED MEDICARE CHOICE
PR50206OtherPREFFERED MEDICARE CHOICE
PR1110940001Medicare NSC