Provider Demographics
NPI:1710580113
Name:GSR PROVIDER AGENCY LLC
Entity Type:Organization
Organization Name:GSR PROVIDER AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:CADENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-567-2078
Mailing Address - Street 1:6101 S CAGE BLVD STE 126
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-9818
Mailing Address - Country:US
Mailing Address - Phone:956-567-2078
Mailing Address - Fax:877-486-8867
Practice Address - Street 1:6101 S CAGE BLVD STE 126
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-9818
Practice Address - Country:US
Practice Address - Phone:956-567-2078
Practice Address - Fax:877-486-8867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty