Provider Demographics
NPI:1043444250
Name:GANTON HOME CARE, LLC
Entity Type:Organization
Organization Name:GANTON HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-787-4150
Mailing Address - Street 1:2121 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3658
Mailing Address - Country:US
Mailing Address - Phone:517-787-4150
Mailing Address - Fax:517-787-4708
Practice Address - Street 1:3600 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-9301
Practice Address - Country:US
Practice Address - Phone:517-990-6444
Practice Address - Fax:517-990-6447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTRYSIDE RETIREMENT COMMUNITY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-04
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI239213Medicare Oscar/Certification