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General NPI Number Information
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NPI Number | 1659238947
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Entity Type | Organization
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Legal Business Name | GARY'S ANGELS LLC
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 479 LADWIG ST
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City | CAMPBELLSPORT
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State | WI
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Zip | 53010-2760
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Country | US
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Telephone | 920-638-0243
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Fax | 920-533-6043
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Provider Business Mailing Address
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Address Line | 479 LADWIG ST
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City | CAMPBELLSPORT
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State | WI
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Zip | 53010-2760
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Country | US
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Telephone | 920-638-0243
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Fax | 920-533-6043
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GARY LEROY POTTER JR.
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Credential |
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Telephone | 920-638-0243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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