Provider Demographics
NPI:1518478445
Name:GLADSTONE AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:GLADSTONE AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-684-3531
Mailing Address - Street 1:PO BOX 328263
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33332-9718
Mailing Address - Country:US
Mailing Address - Phone:954-684-3531
Mailing Address - Fax:
Practice Address - Street 1:19366 SW 65TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33332-3362
Practice Address - Country:US
Practice Address - Phone:954-684-3531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management