Healthcare Provider Details

I. General information

NPI: 1699100297
Provider Name (Legal Business Name): GAIL'S GARDEN OF GOLD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 IRVING AVE
EDEN NC
27288-5510
US

IV. Provider business mailing address

904 IRVING AVE
EDEN NC
27288-5510
US

V. Phone/Fax

Practice location:
  • Phone: 336-432-7400
  • Fax: 336-623-7016
Mailing address:
  • Phone: 336-432-7400
  • Fax: 336-623-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. GAIL BROOKLIN EAVES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-432-7400