Provider Demographics
NPI:1417186404
Name:GLECO LLC
Entity Type:Organization
Organization Name:GLECO LLC
Other - Org Name:D' ADAMS FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/ BOARD MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEODIGAERLAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PANOPIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-963-0416
Mailing Address - Street 1:18101 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6324
Mailing Address - Country:US
Mailing Address - Phone:760-371-5153
Mailing Address - Fax:
Practice Address - Street 1:11665 CIBOLA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-5922
Practice Address - Country:US
Practice Address - Phone:760-963-0416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366413177320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities