MEDICARE: GIBRALTAR SERVICES CONSULTING, INC.

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
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1205100484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIBRALTAR SERVICES CONSULTING, INC.

Provider Business Mailing Address
First Line	:	8229 BRAIDS BEND CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-1977
Country	:	US
Telephone Number	:	704-965-4765
Fax Number	:

Provider Business Practice Location Address
First Line	:	8229 BRAIDS BEND CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-1977
Country	:	US
Telephone Number	:	704-965-4765
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MS. KELLIE A ANDERSON
Credential	:
Telephone Number	:	704-965-4765

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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