MEDICARE: GIDEON'S GATE MANAGMENT AND TECHNICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor		IN
2	374U00000X	Home Health Aide		IN
3	284300000X	Special Hospital		IN
4	103T00000X	Psychologist	20040411A	IN
5	343900000X	Non-emergency Medical Transport (VAN)	1638362	IN
6	347C00000X	Private Vehicle	1638362	IN
7	347B00000X	Bus	1638362	IN
8	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1114111788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIDEON'S GATE MANAGMENT AND TECHNICAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 44319
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46244-0319
Country	:	US
Telephone Number	:	317-536-1225
Fax Number	:

Provider Business Practice Location Address
First Line	:	546 E 17TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1702
Country	:	US
Telephone Number	:	317-536-1225
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/PASTOR
Name	:	MS. CAROL Y WOODARD
Credential	:	ELDER
Telephone Number	:	317-664-1600

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	09/06/2007

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