Provider Demographics
NPI:1306184130
Name:GS OUTPATIENT FACILITIES
Entity Type:Organization
Organization Name:GS OUTPATIENT FACILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEJUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-893-3333
Mailing Address - Street 1:PO BOX 777851
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-7851
Mailing Address - Country:US
Mailing Address - Phone:702-893-3333
Mailing Address - Fax:702-893-0960
Practice Address - Street 1:2821 W HORIZON RIDGE PKWY.
Practice Address - Street 2:SUITE 101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-839-0091
Practice Address - Fax:702-839-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV201116849032251C2600X, 2251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1702161Medicaid
NVCCN294507Medicare PIN
NV1702161Medicaid
NVGG318AMedicare PIN