Provider Demographics
NPI:1942568753
Name:GIAVONNIS
Entity Type:Organization
Organization Name:GIAVONNIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:RONDESHYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:COSBY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:315-412-4900
Mailing Address - Street 1:76 LOUISE ST
Mailing Address - Street 2:
Mailing Address - City:GATES
Mailing Address - State:NC
Mailing Address - Zip Code:27937
Mailing Address - Country:US
Mailing Address - Phone:315-412-4900
Mailing Address - Fax:
Practice Address - Street 1:1095 UNION BRANCH RD
Practice Address - Street 2:
Practice Address - City:CORAPEAKE
Practice Address - State:NC
Practice Address - Zip Code:27926-9629
Practice Address - Country:US
Practice Address - Phone:315-412-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70915251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health