MEDICARE: GILLEY ENTERPRISES LLC

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1831962091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILLEY ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	PO BOX 82
Second Line	:
City	:	JEREMIAH
State	:	KY
Zip	:	41826-0082
Country	:	US
Telephone Number	:	606-633-8058
Fax Number	:	606-633-2414

Provider Business Practice Location Address
First Line	:	2381 HIGHWAY 7 S
Second Line	:
City	:	JEREMIAH
State	:	KY
Zip	:	41826-9081
Country	:	US
Telephone Number	:	606-633-8058
Fax Number	:	606-633-2414

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. SHAWN A GILLEY
Credential	:
Telephone Number	:	606-821-6252

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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