Provider Demographics
NPI:1679834949
Name:G.S.M., INC. - EAST
Entity Type:Organization
Organization Name:G.S.M., INC. - EAST
Other - Org Name:G.S.M., INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-743-4020
Mailing Address - Street 1:3490 GREENLY ST
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-2218
Mailing Address - Country:US
Mailing Address - Phone:810-743-4020
Mailing Address - Fax:810-743-7370
Practice Address - Street 1:3490 GREENLY ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-2218
Practice Address - Country:US
Practice Address - Phone:810-743-4020
Practice Address - Fax:810-743-7370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:G.S.M., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL250314581261QM0850X, 320600000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness