Provider Demographics
NPI:1922834001
Name:GHPS GOUSSE HEALTH PRODUCTS AND SUPPLIES LLC
Entity type:Organization
Organization Name:GHPS GOUSSE HEALTH PRODUCTS AND SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:ETIENNE
Authorized Official - Last Name:GOUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-362-2720
Mailing Address - Street 1:3580 PADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3521
Mailing Address - Country:US
Mailing Address - Phone:954-362-2720
Mailing Address - Fax:954-362-2762
Practice Address - Street 1:21097 NE 27TH CT STE 200
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1237
Practice Address - Country:US
Practice Address - Phone:954-993-0422
Practice Address - Fax:954-362-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service