Healthcare Provider Details

I. General information

NPI: 1689619173
Provider Name (Legal Business Name): GARDNER ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 CHANNINGWAY BLVD. SUITE 205
COLUMBUS OH
43232-2955
US

IV. Provider business mailing address

6100 CHANNINGWAY BLVD. SUITE 205
COLUMBUS OH
43232-2955
US

V. Phone/Fax

Practice location:
  • Phone: 614-861-0861
  • Fax: 614-861-8026
Mailing address:
  • Phone: 614-861-0861
  • Fax: 614-861-8026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELIQUE MARIA PORTER
Title or Position: CEO/OWNER
Credential:
Phone: 614-861-0861