Provider Demographics
NPI:1942668710
Name:GLADSTONE PROPERTIES LLC
Entity Type:Organization
Organization Name:GLADSTONE PROPERTIES LLC
Other - Org Name:GLADSTONE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDRAE
Authorized Official - Middle Name:LEMOYNE
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:RT(T),MBS,CSCM
Authorized Official - Phone:630-581-8513
Mailing Address - Street 1:100 ILLINOIS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1867
Mailing Address - Country:US
Mailing Address - Phone:630-581-8513
Mailing Address - Fax:630-581-8612
Practice Address - Street 1:100 ILLINOIS ST STE 200
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1867
Practice Address - Country:US
Practice Address - Phone:630-581-8513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle