Healthcare Provider Details

I. General information

NPI: 1982249207
Provider Name (Legal Business Name): G&O ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 S MARTIN LUTHER KING JR BLVD
LANSING MI
48911-3544
US

IV. Provider business mailing address

5455 S MARTIN LUTHER KING JR BLVD
LANSING MI
48911-3544
US

V. Phone/Fax

Practice location:
  • Phone: 517-642-5097
  • Fax:
Mailing address:
  • Phone: 517-642-5097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GARTH D HUTTON
Title or Position: ADMINISTRATOR
Credential: NP
Phone: 408-921-7062