Provider Demographics
NPI:1689056368
Name:GERONTECTURE, LLC
Entity Type:Organization
Organization Name:GERONTECTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-426-4041
Mailing Address - Street 1:4240 BIRDELLA DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7366
Mailing Address - Country:US
Mailing Address - Phone:757-426-4041
Mailing Address - Fax:757-657-4353
Practice Address - Street 1:4240 BIRDELLA DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7366
Practice Address - Country:US
Practice Address - Phone:757-426-4041
Practice Address - Fax:757-657-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management