1376628578 NPI number — GIBSON CARE CORP.

Table of content: (NPI 1376628578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376628578 NPI number — GIBSON CARE CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GIBSON CARE CORP.
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:
HOME INSTEAD SENIOR CARE
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:
1376628578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7138
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28687-7138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-924-9909
Provider Business Mailing Address Fax Number:
704-924-9165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 SIGNAL HILL DRIVE EXT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28625-4353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-924-9909
Provider Business Practice Location Address Fax Number:
704-924-9165
Provider Enumeration Date:
10/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
CREIGHTON
Authorized Official Title or Position:
FRANCHISE OWNER
Authorized Official Telephone Number:
704-924-9909

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC3016 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: HC3016 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3418026 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6601285 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".