Healthcare Provider Details

I. General information

NPI: 1831962091
Provider Name (Legal Business Name): GILLEY ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2381 HIGHWAY 7 S
JEREMIAH KY
41826-9081
US

IV. Provider business mailing address

PO BOX 82
JEREMIAH KY
41826-0082
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-8058
  • Fax: 606-633-2414
Mailing address:
  • Phone: 606-633-8058
  • Fax: 606-633-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAWN A GILLEY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 606-821-6252