Provider Demographics
NPI:1780313825
Name:GIDEONS, PROMISSE
Entity type:Individual
Prefix:
First Name:PROMISSE
Middle Name:
Last Name:GIDEONS
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 1:558 MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-1731
Mailing Address - Country:US
Mailing Address - Phone:330-285-1302
Mailing Address - Fax:
Practice Address - Street 1:558 MIAMI AVE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-1731
Practice Address - Country:US
Practice Address - Phone:330-285-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care