Provider Demographics
NPI:1831962091
Name:GILLEY ENTERPRISES LLC
Entity type:Organization
Organization Name:GILLEY ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-821-6252
Mailing Address - Street 1:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:JEREMIAH
Mailing Address - State:KY
Mailing Address - Zip Code:41826-0082
Mailing Address - Country:US
Mailing Address - Phone:606-633-8058
Mailing Address - Fax:606-633-2414
Practice Address - Street 1:2381 HIGHWAY 7 S
Practice Address - Street 2:
Practice Address - City:JEREMIAH
Practice Address - State:KY
Practice Address - Zip Code:41826-9081
Practice Address - Country:US
Practice Address - Phone:606-633-8058
Practice Address - Fax:606-633-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty