Provider Demographics
NPI:1447407705
Name:GEMINICARES, INC.
Entity Type:Organization
Organization Name:GEMINICARES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PETRILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-644-7480
Mailing Address - Street 1:840 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:SLINGER
Mailing Address - State:WI
Mailing Address - Zip Code:53086-9135
Mailing Address - Country:US
Mailing Address - Phone:262-744-7480
Mailing Address - Fax:262-644-7481
Practice Address - Street 1:840 ENTERPRISE DRIVE
Practice Address - Street 2:
Practice Address - City:SLINGER
Practice Address - State:WI
Practice Address - Zip Code:53086-0230
Practice Address - Country:US
Practice Address - Phone:262-744-7480
Practice Address - Fax:262-644-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100008353Medicaid