Provider Demographics
NPI:1942039649
Name:GACHANJU INC
Entity type:Organization
Organization Name:GACHANJU INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GATIBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-619-6811
Mailing Address - Street 1:769 CENTRE ST STE 214
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2557
Mailing Address - Country:US
Mailing Address - Phone:617-337-3863
Mailing Address - Fax:
Practice Address - Street 1:769 CENTRE ST STE 214
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2557
Practice Address - Country:US
Practice Address - Phone:617-337-3863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care