Healthcare Provider Details

I. General information

NPI: 1558278903
Provider Name (Legal Business Name): MICHAEL GARDINER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

783 ENTRY MT RD
FRANKLIN WV
26807
US

IV. Provider business mailing address

783 ENTRY MT RD
FRANKLIN WV
26807
US

V. Phone/Fax

Practice location:
  • Phone: 419-554-0400
  • Fax:
Mailing address:
  • Phone: 419-554-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: