Provider Demographics
NPI:1164668059
Name:GOS OPERATOR LLC
Entity Type:Organization
Organization Name:GOS OPERATOR LLC
Other - Org Name:GORDON OAKS HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCAULIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-661-7608
Mailing Address - Street 1:3151A KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-2745
Mailing Address - Country:US
Mailing Address - Phone:251-661-7608
Mailing Address - Fax:251-602-9146
Practice Address - Street 1:3151A KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-2745
Practice Address - Country:US
Practice Address - Phone:251-661-7608
Practice Address - Fax:251-602-9146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5525 (NH)314000000X
AL5527 (SCALF)314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL47-579905Medicaid
015432Medicare Oscar/Certification