Provider Demographics
NPI:1265720742
Name:GIESENHAGEN ENTERPRISES, INC.
Entity type:Organization
Organization Name:GIESENHAGEN ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-232-2878
Mailing Address - Street 1:1343 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2457
Mailing Address - Country:US
Mailing Address - Phone:816-232-2878
Mailing Address - Fax:816-232-5056
Practice Address - Street 1:1343 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2457
Practice Address - Country:US
Practice Address - Phone:816-232-2878
Practice Address - Fax:816-232-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266508Medicare Oscar/Certification