Provider Demographics
NPI:1952868515
Name:GB 3445, LLC
Entity Type:Organization
Organization Name:GB 3445, LLC
Other - Org Name:RESTORIXHEALTH AT-HOME WOUND CARE SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-556-0200
Mailing Address - Street 1:3445 N CAUSEWAY BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3762
Mailing Address - Country:US
Mailing Address - Phone:504-609-3282
Mailing Address - Fax:
Practice Address - Street 1:3445 N CAUSEWAY BLVD STE 601
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3750
Practice Address - Country:US
Practice Address - Phone:504-609-3282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1952868515Medicaid
WA2172055Medicaid
LADME.001209OtherDME
GAPHDME000737OtherDME
IA0129611Medicaid
MS18332OtherDME
KS201315040AMedicaid
SC20455OtherDME LICENSE
NM93057521Medicaid
CTCSW.0004594OtherDME LICENSE
VA0237000553OtherDME
WV1952868515Medicaid
AR270350716Medicaid
CTCSW.0004594OtherDME
HIDME-0299OtherDME
HIDME0299OtherDME LICENSE
GAPHDME000737OtherDME LICENSE
NE10026846500Medicaid
NC1952868515Medicaid
MI1952868515Medicaid
OK200944570AMedicaid
SD2022293Medicaid
LA2594834Medicaid
KY7100703750Medicaid
SCDM1704Medicaid
GA003243376AMedicaid
LADME.001209OtherDME LICENSE
NC02914OtherDME LICENSE