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NPI Code Detail

MEDICARE: GINI MCILROY

MEDICARE: GINI MCILROY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1385HR2060XChild Intellectual and/or Developmental Disabilities Respite Care

General Provider Information

NPI Number : 1033872965
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINI MCILROY
Provider Business Mailing Address
First Line : 1440 E EMPIRE AVE
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-2020
Country : US
Telephone Number : 269-487-9820
Fax Number :
Provider Business Practice Location Address
First Line : 1440 E EMPIRE AVE
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-2020
Country : US
Telephone Number : 269-487-9820
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2021
Last Update Date : 10/18/2021

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Directions to “ GINI MCILROY ” Practice Location

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