Healthcare Provider Details

I. General information

NPI: 1356613350
Provider Name (Legal Business Name): WILLIAMGABLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 S KENNEBEC AVE
MCCONNELSVILLE OH
43756-1211
US

IV. Provider business mailing address

137 S KENNEBEC AVE
MCCONNELSVILLE OH
43756-1211
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-5727
  • Fax: 740-962-5727
Mailing address:
  • Phone: 740-962-5727
  • Fax: 740-962-6393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateOH

VIII. Authorized Official

Name: MRS. LORI ANN ALLEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 740-962-5727