Healthcare Provider Details

I. General information

NPI: 1629867403
Provider Name (Legal Business Name): GNL HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 LEXINGTON RD
MONTGOMERY AL
36111-1329
US

IV. Provider business mailing address

1710 NORMAN BRIDGE RD
MONTGOMERY AL
36104-5631
US

V. Phone/Fax

Practice location:
  • Phone: 470-829-4037
  • Fax:
Mailing address:
  • Phone: 470-829-4037
  • Fax: 470-829-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE L GRESHAM
Title or Position: OFFICE MANAGER
Credential:
Phone: 334-840-9632