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General NPI Number Information
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NPI Number | 1114141439
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Entity Type | Organization
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Legal Business Name | DONNA J GREGORY
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 513 MILL STREET
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City | ALTON
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State | KS
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Zip | 67623
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Country | US
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Telephone | 785-984-2290
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Fax | 785-984-2293
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Provider Business Mailing Address
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Address Line | 1354 C 657TH AVE
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City | ALTON
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State | KS
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Zip | 67623
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Country | US
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Telephone | 785-984-2290
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Fax | 785-984-2293
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Authorized Official
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Title or Position | OWNER
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Name | DONNA J GREGORY
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Credential | RN
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Telephone | 785-984-2290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | B003831462
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License Number State | KS
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