Provider Demographics
NPI:1023204690
Name:GADSDEN SENIOR SERVICES
Entity Type:Organization
Organization Name:GADSDEN SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNIGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-627-9758
Mailing Address - Street 1:79 LASALLE LEFFAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351
Mailing Address - Country:US
Mailing Address - Phone:850-627-9785
Mailing Address - Fax:850-875-4524
Practice Address - Street 1:79 LASALLE LEFALL DRIVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351
Practice Address - Country:US
Practice Address - Phone:850-627-9758
Practice Address - Fax:850-875-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229305251B00000X
253Z00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020827800Medicaid