NPIMap

Organization Active NPI

Gwenandrews Home of Success Agency, Inc.

  • Child Intellectual and/or Developmental Disabilities Respite Care
  • Quincy, FL
National Provider Identifier
1346676848
Registry record updated Sep 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child Intellectual and/or Developmental Disabilities Respite CareTaxonomy code 385HR2060X
License
691333496 Issued in FL
Legal business name
GWENANDREWS HOME OF SUCCESS AGENCY, INC.
Practice address
116 N Madison St
Quincy, FL 32351-2411
Phone
(850) 875-0075
Fax
(850) 627-2614
NPI assigned
Sep 17, 2013
Last updated
Sep 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Ereka Andrews ReddickNPI 1073909842
Title
Executive Director
Phone
(850) 875-0075

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X 691333496 FL Primary

Addresses

Primary practice location

116 N Madison St
Quincy, FL 32351-2411

Mailing address

116 N Madison St
Quincy, FL 32351-2411
Phone (850) 875-0075

Other identifiers 2

IdentifierTypeStateIssuer
691333496MedicaidFL
002214300MedicaidFL

National Provider Directory

National Provider Directory

Locations

116 N Madison St
Quincy, FL 32351
Phone (850) 875-0075

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379376000000",
    "number": "1346676848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 N MADISON ST",
            "city": "QUINCY",
            "state": "FL",
            "postal_code": "323512411",
            "telephone_number": "850-875-0075",
            "fax_number": "850-627-2614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 N MADISON ST",
            "city": "QUINCY",
            "state": "FL",
            "postal_code": "323512411",
            "telephone_number": "850-875-0075",
            "fax_number": "850-627-2614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWENANDREWS HOME OF SUCCESS AGENCY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-17",
        "last_updated": "2013-09-17",
        "status": "A",
        "authorized_official_last_name": "REDDICK",
        "authorized_official_first_name": "EREKA",
        "authorized_official_middle_name": "ANDREWS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "850-875-0075",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "FL",
            "license": "691333496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "691333496",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002214300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.