MEDICARE: WILLIAMGABLE

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	311ZA0620X	Adult Care Home Facility		OH

General Provider Information

NPI Number	:	1356613350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMGABLE

Provider Business Mailing Address
First Line	:	137 S KENNEBEC AVE
Second Line	:
City	:	MCCONNELSVILLE
State	:	OH
Zip	:	43756-1211
Country	:	US
Telephone Number	:	740-962-5727
Fax Number	:	740-962-6393

Provider Business Practice Location Address
First Line	:	137 S KENNEBEC AVE
Second Line	:
City	:	MCCONNELSVILLE
State	:	OH
Zip	:	43756-1211
Country	:	US
Telephone Number	:	740-962-5727
Fax Number	:	740-962-5727

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LORI ANN ALLEN
Credential	:
Telephone Number	:	740-962-5727

Provider Enumeration Date	:	02/07/2012
Last Update Date	:	07/21/2022

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Directions to “WILLIAMGABLE ” Practice Location

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