Provider Demographics
NPI:1609054477
Name:GBL ENTERPRISES, LLC
Entity Type:Organization
Organization Name:GBL ENTERPRISES, LLC
Other - Org Name:BARBARA'S MASTECTOMY BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-980-4007
Mailing Address - Street 1:5350 N 16TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3213
Mailing Address - Country:US
Mailing Address - Phone:602-234-9568
Mailing Address - Fax:602-957-2562
Practice Address - Street 1:5350 N 16TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3213
Practice Address - Country:US
Practice Address - Phone:602-234-9568
Practice Address - Fax:602-957-2562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1117200001Medicare NSC