Healthcare Provider Details

I. General information

NPI: 1720772858
Provider Name (Legal Business Name): MY 3 GIBBYS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W PATRICK ST
FREDERICK MD
21701-4887
US

IV. Provider business mailing address

414 HUNGERFORD DR STE 448
ROCKVILLE MD
20850-5118
US

V. Phone/Fax

Practice location:
  • Phone: 240-651-5876
  • Fax:
Mailing address:
  • Phone: 301-340-0100
  • Fax:

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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DAVID RANDALL GIBSON
Title or Position: PRESIDENT
Credential:
Phone: 301-340-0100