Provider Demographics
NPI:1255543211
Name:GEMSONS CORPORATION
Entity type:Organization
Organization Name:GEMSONS CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUSEBIO
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:818-956-9878
Mailing Address - Street 1:412 W BROADWAY
Mailing Address - Street 2:SUITE 216
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4117
Mailing Address - Country:US
Mailing Address - Phone:818-856-9878
Mailing Address - Fax:818-956-9872
Practice Address - Street 1:416 W BROADWAY
Practice Address - Street 2:SUITE 216
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4117
Practice Address - Country:US
Practice Address - Phone:818-956-9878
Practice Address - Fax:818-956-9872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000438251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550000438OtherDHS STATE LICENSE
CA059339Medicare Oscar/Certification