Healthcare Provider Details

I. General information

NPI: 1437734225
Provider Name (Legal Business Name): GANTT HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N MULBERRY ST
MOUNT VERNON OH
43050-2056
US

IV. Provider business mailing address

PO BOX 990
MOUNT VERNON OH
43050-7990
US

V. Phone/Fax

Practice location:
  • Phone: 740-326-6097
  • Fax:
Mailing address:
  • Phone: 740-501-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JULIA BOGGS
Title or Position: CEO
Credential:
Phone: 740-326-6097