Provider Demographics
NPI:1770268195
Name:GASKIN, KAROLE ANNE
Entity type:Individual
Prefix:
First Name:KAROLE
Middle Name:ANNE
Last Name:GASKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 HUNTINGDON DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-3586
Mailing Address - Country:US
Mailing Address - Phone:609-525-7783
Mailing Address - Fax:
Practice Address - Street 1:2515 W 4TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-2334
Practice Address - Country:US
Practice Address - Phone:610-877-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6321361251E00000X, 171M00000X, 101YP1600X, 174200000X, 261QR0400X, 310400000X, 3104A0630X, 372600000X, 374U00000X, 376K00000X, 385H00000X, 332U00000X
311ZA0620X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No174200000XOther Service ProvidersMeals
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No332U00000XSuppliersHome Delivered Meals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104033933-0001OtherPROVIDER ID NUMBER
PA1040339330001Medicaid
PA104033933-001OtherPROMISE NUMBER