Provider Demographics
NPI:1982910493
Name:G-WASA, INC.
Entity Type:Organization
Organization Name:G-WASA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ATKINSON-LIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-785-9362
Mailing Address - Street 1:10700 RICHMOND AVE
Mailing Address - Street 2:STE. 121
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4925
Mailing Address - Country:US
Mailing Address - Phone:713-785-9362
Mailing Address - Fax:713-785-5081
Practice Address - Street 1:10700 RICHMOND AVE
Practice Address - Street 2:STE. 121
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4925
Practice Address - Country:US
Practice Address - Phone:713-785-9362
Practice Address - Fax:713-785-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X, 253J00000X, 253Z00000X, 302F00000X, 302R00000X, 305R00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid