Provider Demographics
NPI:1699197830
Name:GSDED, LLC
Entity Type:Organization
Organization Name:GSDED, LLC
Other - Org Name:INTERIM HEALTHCARE SLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-401-3515
Mailing Address - Street 1:2020 S 1300 E
Mailing Address - Street 2:SUITE C
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3654
Mailing Address - Country:US
Mailing Address - Phone:801-401-3515
Mailing Address - Fax:801-401-3503
Practice Address - Street 1:2020 S 1300 E
Practice Address - Street 2:SUITE C
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-3654
Practice Address - Country:US
Practice Address - Phone:801-401-3515
Practice Address - Fax:801-401-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health