=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699100297
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAIL'S GARDEN OF GOLD CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2013
-----------------------------------------------------
Last Update Date | 04/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 904 IRVING AVE
-----------------------------------------------------
City | EDEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27288-5510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-432-7400
-----------------------------------------------------
Fax | 336-623-7016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 904 IRVING AVE
-----------------------------------------------------
City | EDEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27288-5510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-432-7400
-----------------------------------------------------
Fax | 336-623-7016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. GAIL BROOKLIN EAVES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-432-7400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------