Provider Demographics
NPI:1912384413
Name:GSD INITIATIVE LLC
Entity Type:Organization
Organization Name:GSD INITIATIVE LLC
Other - Org Name:OPTIMAL HOME CARE LOVELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VERGEIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-304-0072
Mailing Address - Street 1:2725 ROCKY MOUNTAIN AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8717
Mailing Address - Country:US
Mailing Address - Phone:970-658-6509
Mailing Address - Fax:970-818-9299
Practice Address - Street 1:2725 ROCKY MOUNTAIN AVE STE 410
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8717
Practice Address - Country:US
Practice Address - Phone:970-658-6509
Practice Address - Fax:970-818-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1740412709Medicaid
CO1740412709Medicare NSC