Provider Demographics
NPI:1427194273
Name:GUM CREEK ENTERPRISES INC
Entity Type:Organization
Organization Name:GUM CREEK ENTERPRISES INC
Other - Org Name:COMFACARE HOME HEALTH SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-356-9111
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:929 4TH ST NW
Mailing Address - City:RED BAY
Mailing Address - State:AL
Mailing Address - Zip Code:35582-1250
Mailing Address - Country:US
Mailing Address - Phone:256-356-9111
Mailing Address - Fax:256-356-9111
Practice Address - Street 1:929 4TH ST NW
Practice Address - Street 2:
Practice Address - City:RED BAY
Practice Address - State:AL
Practice Address - Zip Code:35582-1250
Practice Address - Country:US
Practice Address - Phone:256-356-9111
Practice Address - Fax:256-356-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440339Medicaid
AL51031062OtherBCBS AL
AL009606550Medicaid
MS00440339Medicaid