Provider Demographics
NPI:1154446466
Name:GAITHER'S FAMILY HOMES INC.
Entity Type:Organization
Organization Name:GAITHER'S FAMILY HOMES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MS
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAITHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-781-0301
Mailing Address - Street 1:1408 S NEWCOMB ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-9354
Mailing Address - Country:US
Mailing Address - Phone:559-920-3939
Mailing Address - Fax:559-686-2693
Practice Address - Street 1:1443 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2378
Practice Address - Country:US
Practice Address - Phone:559-687-0301
Practice Address - Fax:559-686-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12000628320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55G097Medicaid