Provider Demographics
NPI:1649582800
Name:GIDEON HEALTHCARE LLC
Entity Type:Organization
Organization Name:GIDEON HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, LNHA
Authorized Official - Phone:937-845-7310
Mailing Address - Street 1:430 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-1455
Mailing Address - Country:US
Mailing Address - Phone:937-845-7310
Mailing Address - Fax:937-845-7327
Practice Address - Street 1:430 N MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-1455
Practice Address - Country:US
Practice Address - Phone:937-845-7310
Practice Address - Fax:937-845-7327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1921921251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health