Provider Demographics
NPI:1932455961
Name:GERIATRIC HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:GERIATRIC HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-537-8025
Mailing Address - Street 1:6198 HICKORY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1422
Mailing Address - Country:US
Mailing Address - Phone:936-537-8025
Mailing Address - Fax:
Practice Address - Street 1:4640 S CARROLLTON AVE
Practice Address - Street 2:SUITE 220-226
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6051
Practice Address - Country:US
Practice Address - Phone:936-537-8025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS258919Medicare PIN
LA247758 YJK0Medicare PIN