Provider Demographics
NPI:1457634065
Name:GOSULA HOMECARE, INC.
Entity Type:Organization
Organization Name:GOSULA HOMECARE, INC.
Other - Org Name:SYNERGY HOMECARE OF SAN MATEO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAILI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-378-2436
Mailing Address - Street 1:1670 S AMPHLETT BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2511
Mailing Address - Country:US
Mailing Address - Phone:650-378-2436
Mailing Address - Fax:
Practice Address - Street 1:1670 S AMPHLETT BLVD STE 214
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2511
Practice Address - Country:US
Practice Address - Phone:650-378-2436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care