Provider Demographics
NPI:1639668973
Name:G&G HOME CARE
Entity Type:Organization
Organization Name:G&G HOME CARE
Other - Org Name:G&G HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAKITA
Authorized Official - Middle Name:HAYES
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-504-8964
Mailing Address - Street 1:203 WINDSOR ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-9604
Mailing Address - Country:US
Mailing Address - Phone:352-504-8964
Mailing Address - Fax:
Practice Address - Street 1:203 WINDSOR ESTATES DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-9604
Practice Address - Country:US
Practice Address - Phone:352-504-8964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL824911555Medicaid