Healthcare Provider Details

I. General information

NPI: 1245221795
Provider Name (Legal Business Name): GERICARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 PICKWICK ST
SAVANNAH TN
38372-1953
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-6626
  • Fax: 731-925-7330
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-233-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0290
License Number StateTN

VIII. Authorized Official

Name: DONALD D. STELLY
Title or Position: PRESIDENT
Credential:
Phone: 337-233-1307