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General NPI Number Information
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NPI Number | 1932285996
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Entity Type | Organization
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Legal Business Name | GERALD JACKSON GALLOUPE
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 1705 NORTH BISHOP
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City | TEXARKANA
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State | TX
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Zip | 75501-2800
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Country | US
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Telephone | 903-838-4941
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Fax | 903-838-5128
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Provider Business Mailing Address
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Address Line | 1705 NORTH BISHOP
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City | TEXARKANA
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State | TX
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Zip | 75501-2800
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Country | US
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Telephone | 903-838-4941
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Fax | 903-838-5128
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. GERALD JACKSON GALLOUPE
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Credential |
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Telephone | 903-838-4941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 002258
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License Number State | TX
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