Provider Demographics
NPI:1861822181
Name:ARBORS AT GALLIPOLIS
Entity Type:Organization
Organization Name:ARBORS AT GALLIPOLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAYLA
Authorized Official - Middle Name:CHANTELLE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:740-446-7112
Mailing Address - Street 1:1236 PIONEER TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:PATRIOT
Mailing Address - State:OH
Mailing Address - Zip Code:45658-8907
Mailing Address - Country:US
Mailing Address - Phone:740-339-2153
Mailing Address - Fax:
Practice Address - Street 1:170 PINECREST DRIVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631
Practice Address - Country:US
Practice Address - Phone:740-446-4112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07181313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility