Provider Demographics
NPI:1578218764
Name:GM HEALTHCARE LLC
Entity type:Organization
Organization Name:GM HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GODWILL
Authorized Official - Middle Name:
Authorized Official - Last Name:NGOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-436-7403
Mailing Address - Street 1:2905 BOSWELL AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-2814
Mailing Address - Country:US
Mailing Address - Phone:703-436-7403
Mailing Address - Fax:
Practice Address - Street 1:2905 BOSWELL AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-2814
Practice Address - Country:US
Practice Address - Phone:703-436-7403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities