Provider Demographics
NPI:1629721659
Name:GILLESPIE SERVICES, INC.
Entity Type:Organization
Organization Name:GILLESPIE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-917-1905
Mailing Address - Street 1:PO BOX 411659
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32941-1659
Mailing Address - Country:US
Mailing Address - Phone:321-917-1905
Mailing Address - Fax:321-733-6471
Practice Address - Street 1:113 E AVENUE D
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1345
Practice Address - Country:US
Practice Address - Phone:321-733-6472
Practice Address - Fax:321-733-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home