Provider Demographics
NPI:1619200235
Name:GILMO RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:GILMO RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISIDAHOMEN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:410-963-2559
Mailing Address - Street 1:4803 HAWKSBURY RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2142
Mailing Address - Country:US
Mailing Address - Phone:410-963-2559
Mailing Address - Fax:410-521-0579
Practice Address - Street 1:4803 HAWKSBURY RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2142
Practice Address - Country:US
Practice Address - Phone:410-963-2559
Practice Address - Fax:410-521-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2762253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR2762OtherDHMH