Provider Demographics
NPI:1689619173
Name:GARDNER ASSOCIATES, LLC
Entity Type:Organization
Organization Name:GARDNER ASSOCIATES, LLC
Other - Org Name:NULIFE HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-861-0861
Mailing Address - Street 1:6100 CHANNINGWAY BLVD.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-2955
Mailing Address - Country:US
Mailing Address - Phone:614-861-0861
Mailing Address - Fax:614-861-8026
Practice Address - Street 1:6100 CHANNINGWAY BLVD.
Practice Address - Street 2:SUITE 205
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2955
Practice Address - Country:US
Practice Address - Phone:614-861-0861
Practice Address - Fax:614-861-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2649227Medicaid
OH2798601OtherOHIO MEDICAID LEGACY NUMBER
OH2798601OtherOHIO MEDICAID LEGACY NUMBER