Provider Demographics
NPI:1659962975
Name:GARLINGTON HALLER VENTURES, LLC
Entity Type:Organization
Organization Name:GARLINGTON HALLER VENTURES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:H
Authorized Official - Last Name:HALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-273-4002
Mailing Address - Street 1:PO BOX 8700
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39506-8700
Mailing Address - Country:US
Mailing Address - Phone:228-273-4002
Mailing Address - Fax:228-273-8922
Practice Address - Street 1:14231 SEAWAY RD STE E4
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4627
Practice Address - Country:US
Practice Address - Phone:228-273-4002
Practice Address - Fax:228-273-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care