Healthcare Provider Details

I. General information

NPI: 1043010697
Provider Name (Legal Business Name): GIGI'S PLACE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 FM 1649
ORE CITY TX
75683-6532
US

IV. Provider business mailing address

12901 FM 1649
ORE CITY TX
75683-6532
US

V. Phone/Fax

Practice location:
  • Phone: 405-465-5286
  • Fax:
Mailing address:
  • Phone: 405-465-5286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GENETIA S DANIELS
Title or Position: PRESIDENT
Credential:
Phone: 405-465-5286