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General NPI Number Information
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NPI Number | 1396998381
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Entity Type | Organization
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Legal Business Name | G&M PROVISIONS INC.
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 7606 GREEN VALLEY ROAD
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City | LEBANON
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State | VA
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Zip | 24266
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Country | US
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Telephone | 276-701-1386
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1913
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City | LEBANON
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State | VA
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Zip | 24266-1913
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Country | US
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Telephone | 276-701-1386
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STARR LYNN PUCKETT
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Credential |
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Telephone | 276-701-1386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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