Provider Demographics
NPI:1871817056
Name:GCN THERAPIES/GENYLIMA/SLP
Entity Type:Organization
Organization Name:GCN THERAPIES/GENYLIMA/SLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-966-3380
Mailing Address - Street 1:5055 S CONGRESS AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4722
Mailing Address - Country:US
Mailing Address - Phone:561-966-3380
Mailing Address - Fax:561-966-7599
Practice Address - Street 1:5055 S CONGRESS AVE STE 304
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4722
Practice Address - Country:US
Practice Address - Phone:561-966-3380
Practice Address - Fax:561-966-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1750439949Medicaid