Provider Demographics
NPI:1093575128
Name:GARRY CONN
Entity Type:Organization
Organization Name:GARRY CONN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-668-2334
Mailing Address - Street 1:4810 SANDSTONE PASS APT 1A
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5010
Mailing Address - Country:US
Mailing Address - Phone:325-668-2334
Mailing Address - Fax:
Practice Address - Street 1:4810 SANDSTONE PASS APT 1A
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5010
Practice Address - Country:US
Practice Address - Phone:325-668-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care