Provider Demographics
NPI:1659750933
Name:GSA HOME CARE LLC.
Entity Type:Organization
Organization Name:GSA HOME CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARKADIY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-915-0838
Mailing Address - Street 1:409 W HALLANDALE BEACH BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5301
Mailing Address - Country:US
Mailing Address - Phone:954-404-7718
Mailing Address - Fax:954-404-7729
Practice Address - Street 1:409 W HALLANDALE BEACH BLVD STE 217
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5301
Practice Address - Country:US
Practice Address - Phone:954-404-7718
Practice Address - Fax:954-404-7729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 253Z00000X
FL233847251E00000X
FL234087251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101658500Medicaid