Provider Demographics
NPI:1982488078
Name:GIBMORE HOLDINGS, LLC
Entity Type:Organization
Organization Name:GIBMORE HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-689-1531
Mailing Address - Street 1:1140 WOOD DALE CIR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5169
Mailing Address - Country:US
Mailing Address - Phone:321-689-1531
Mailing Address - Fax:
Practice Address - Street 1:1221 E BROADWAY ST STE 1031
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7829
Practice Address - Country:US
Practice Address - Phone:407-602-6236
Practice Address - Fax:407-636-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)