Provider Demographics
NPI:1013214691
Name:GAINES, GLADYS A
Entity Type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:A
Last Name:GAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1162
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:FL
Mailing Address - Zip Code:33834-1162
Mailing Address - Country:US
Mailing Address - Phone:863-253-7510
Mailing Address - Fax:863-386-9117
Practice Address - Street 1:5109 STURGEON DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1173
Practice Address - Country:US
Practice Address - Phone:863-253-7510
Practice Address - Fax:863-386-9117
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0700X, 251E00000X, 252Y00000X, 253Z00000X, 251300000X, 343900000X, 385HR2060X, 390200000X, 320700000X, 320800000X
FL103TS0200X, 172A00000X, 222Q00000X, 251C00000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No251300000XAgenciesLocal Education Agency (LEA)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No172A00000XOther Service ProvidersDriver
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000309700Medicaid
FL002313900Medicaid
FL002536200Medicaid
FL000630100Medicaid
FL002313600Medicaid