Provider Demographics
NPI:1578179982
Name:GORDRELL ENTERPRISES LLC
Entity Type:Organization
Organization Name:GORDRELL ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TOMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-946-5504
Mailing Address - Street 1:2244 S HAMILTON RD STE 101C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4390
Mailing Address - Country:US
Mailing Address - Phone:855-519-2787
Mailing Address - Fax:
Practice Address - Street 1:2244 S HAMILTON RD STE 101C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4390
Practice Address - Country:US
Practice Address - Phone:855-519-2787
Practice Address - Fax:614-868-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347B00000XTransportation ServicesBus
No347E00000XTransportation ServicesTransportation Broker