Provider Demographics
NPI:1689889164
Name:AMERICAN GOTHIC HOME CARE
Entity Type:Organization
Organization Name:AMERICAN GOTHIC HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:HINDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-652-3400
Mailing Address - Street 1:500 CHURCH STREET
Mailing Address - Street 2:PO BOX 397
Mailing Address - City:ELDON
Mailing Address - State:IA
Mailing Address - Zip Code:52554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:IA
Practice Address - Zip Code:52554
Practice Address - Country:US
Practice Address - Phone:641-652-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0217950251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health