Provider Demographics
NPI:1477752459
Name:GLOSS ENTERPRISE, LLC
Entity Type:Organization
Organization Name:GLOSS ENTERPRISE, LLC
Other - Org Name:GLOSS ENTERPRISE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-419-2430
Mailing Address - Street 1:1814 N MORRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-1551
Mailing Address - Country:US
Mailing Address - Phone:985-419-2430
Mailing Address - Fax:985-419-2431
Practice Address - Street 1:1814 N MORRISON BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-1551
Practice Address - Country:US
Practice Address - Phone:985-419-2430
Practice Address - Fax:985-419-2431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLOSS ENTERPRISE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-11
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1469599MedicaidCHILDREN'S CHOICE