Provider Demographics
NPI:1508105727
Name:GERIATRIC HEALTH SERVICES, PLC
Entity Type:Organization
Organization Name:GERIATRIC HEALTH SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:GNP
Authorized Official - Phone:602-616-1332
Mailing Address - Street 1:1013 W LONGHORN RD
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4282
Mailing Address - Country:US
Mailing Address - Phone:602-616-1332
Mailing Address - Fax:928-474-8947
Practice Address - Street 1:1013 W LONGHORN RD
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4282
Practice Address - Country:US
Practice Address - Phone:602-616-1332
Practice Address - Fax:928-474-8947
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOIS MARION JUDD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1189363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMJ0163080OtherDEA
AZMJ0163080OtherDEA