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General NPI Number Information
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NPI Number | 1982488078
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Entity Type | Organization
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Legal Business Name | GIBMORE HOLDINGS, LLC
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 1221 E BROADWAY ST STE 1031
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City | OVIEDO
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State | FL
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Zip | 32765-7829
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Country | US
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Telephone | 407-602-6236
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Fax | 407-636-2938
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Provider Business Mailing Address
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Address Line | 1140 WOOD DALE CIR
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City | OVIEDO
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State | FL
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Zip | 32765-5169
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Country | US
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Telephone | 321-689-1531
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | HEATHER SIZEMORE
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Credential |
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Telephone | 321-689-1531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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