Provider Demographics
NPI:1417559410
Name:GAUCIN, ANGIE L
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:L
Last Name:GAUCIN
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 1:824 E RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-1860
Mailing Address - Country:US
Mailing Address - Phone:567-264-4055
Mailing Address - Fax:
Practice Address - Street 1:824 E RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1860
Practice Address - Country:US
Practice Address - Phone:567-264-4055
Practice Address - Fax:567-264-4064
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3500250Medicaid
OH2760758Medicaid