Provider Demographics
NPI:1255309803
Name:G S S C LTD PARTNERSHIP
Entity type:Organization
Organization Name:G S S C LTD PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-929-7229
Mailing Address - Street 1:2288 AUBURN BLVD
Mailing Address - Street 2:#201
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-1618
Mailing Address - Country:US
Mailing Address - Phone:916-929-7229
Mailing Address - Fax:916-929-2590
Practice Address - Street 1:2288 AUBURN BLVD
Practice Address - Street 2:#201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-1618
Practice Address - Country:US
Practice Address - Phone:916-929-7229
Practice Address - Fax:916-929-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26030000116261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR11465HMedicaid
CAZZZ27857ZMedicare ID - Type Unspecified