Provider Demographics
NPI:1174969331
Name:GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION
Entity type:Organization
Organization Name:GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:GILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:671-735-7101
Mailing Address - Street 1:123 CHALAN KARETA
Mailing Address - Street 2:
Mailing Address - City:MANGILAO
Mailing Address - State:GU
Mailing Address - Zip Code:96913-6304
Mailing Address - Country:US
Mailing Address - Phone:671-735-7111
Mailing Address - Fax:671-734-7097
Practice Address - Street 1:123 CHALAN KARETA
Practice Address - Street 2:
Practice Address - City:MANGILAO
Practice Address - State:GU
Practice Address - Zip Code:96913-6304
Practice Address - Country:US
Practice Address - Phone:671-735-7111
Practice Address - Fax:671-734-7097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service