Provider Demographics
NPI:1922357052
Name:GBLONG LLC
Entity Type:Organization
Organization Name:GBLONG LLC
Other - Org Name:AMAZING - GRACE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUWAGBEMIGA
Authorized Official - Middle Name:OLANIYI
Authorized Official - Last Name:LONGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-627-5680
Mailing Address - Street 1:18438 AUSTIN OAK LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2276
Mailing Address - Country:US
Mailing Address - Phone:281-762-0499
Mailing Address - Fax:281-762-0499
Practice Address - Street 1:18438 AUSTIN OAK LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2276
Practice Address - Country:US
Practice Address - Phone:281-762-0499
Practice Address - Fax:281-762-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health