=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366959272
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GILLISPIE EMPLOYMENT & TRAINING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2018
-----------------------------------------------------
Last Update Date | 01/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 990 IH 10 N
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77702-1051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-499-8216
-----------------------------------------------------
Fax | 409-767-8772
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7475 CONCORD RD
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77708-2824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-499-8216
-----------------------------------------------------
Fax | 409-767-8772
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. SHERRELL R GILLISPIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 409-499-8216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 273Y00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------