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General NPI Number Information
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NPI Number | 1568741262
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Entity Type | Organization
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Legal Business Name | GLADSTONE HEADQUARTERS, INC
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 717 S MAIN ST
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City | NORTH CANTON
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State | OH
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Zip | 44720-3009
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Country | US
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Telephone | 330-433-1080
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Fax | 330-433-1086
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Provider Business Mailing Address
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Address Line | 717 S MAIN ST
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City | NORTH CANTON
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State | OH
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Zip | 44720-3009
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Country | US
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Telephone | 330-433-1080
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Fax | 330-433-1086
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Authorized Official
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Title or Position | OWNER/CEO
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Name | VICKI STANLEY
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Credential |
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Telephone | 330-433-1080
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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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