Provider Demographics
NPI:1407070949
Name:GERICARE INC.
Entity Type:Organization
Organization Name:GERICARE INC.
Other - Org Name:GERICARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KUMUD
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:817-704-9882
Mailing Address - Street 1:2317 STARLIGHT CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-6425
Mailing Address - Country:US
Mailing Address - Phone:817-704-9882
Mailing Address - Fax:817-277-5842
Practice Address - Street 1:2317 STARLIGHT CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-6425
Practice Address - Country:US
Practice Address - Phone:817-704-9882
Practice Address - Fax:817-704-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X981OtherMEDICARE PTAN
TXP00413519OtherMEDICARE RAILROAD
TX149175503Medicaid
TX00X981Medicare UPIN