Provider Demographics
NPI:1205291911
Name:GMW I CARE SUPPORT SERVICES
Entity type:Organization
Organization Name:GMW I CARE SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENORA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-389-0628
Mailing Address - Street 1:10209 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7021
Mailing Address - Country:US
Mailing Address - Phone:813-389-0628
Mailing Address - Fax:813-631-1429
Practice Address - Street 1:10209 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7021
Practice Address - Country:US
Practice Address - Phone:813-422-7293
Practice Address - Fax:813-423-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL692384496251C00000X, 385HR2065X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692384496Medicaid
FL692384496OtherMEDICARE