1952868515 NPI number — GB 3445, LLC

Table of content: (NPI 1952868515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952868515 NPI number — GB 3445, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GB 3445, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RESTORIXHEALTH AT-HOME WOUND CARE SUPPLIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952868515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3445 N CAUSEWAY BLVD STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70002-3762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-609-3282
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3445 N CAUSEWAY BLVD STE 601
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70002-3750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-609-3282
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BOWMAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-556-0200

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1952868515 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2172055 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DME.001209 . This is a "DME" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: PHDME000737 . This is a "DME" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0129611 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18332 . This is a "DME" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 201315040A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20455 . This is a "DME LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 93057521 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: CSW.0004594 . This is a "DME LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0237000553 . This is a "DME" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1952868515 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 270350716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: CSW.0004594 . This is a "DME" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: DME-0299 . This is a "DME" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: DME0299 . This is a "DME LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: PHDME000737 . This is a "DME LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 10026846500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1952868515 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1952868515 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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