Healthcare Provider Details

I. General information

NPI: 1447888912
Provider Name (Legal Business Name): GORDRELL ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2246 S HAMILTON RD STE 100
COLUMBUS OH
43232-4317
US

IV. Provider business mailing address

2246 S HAMILTON RD STE 100
COLUMBUS OH
43232-4317
US

V. Phone/Fax

Practice location:
  • Phone: 614-946-5504
  • Fax:
Mailing address:
  • Phone: 614-946-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TOMIKA DARNELL GORDON
Title or Position: CEO
Credential:
Phone: 614-379-8787