Danny Gantt – Rehabilitation Practitioner

Key facts

NPI: 1558055913
Entity type: Individual (NPI type 1)
Primary specialty: Rehabilitation Practitioner 225400000X
Practice address: 21935 Van Buren St Ste A1
Grand Terrace, CA 92313-5652
Phone: (909) 906-1023
NPI assigned: Jun 7, 2023
Sex: Male
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

The Heart Matters Foster Family Agency Foster Care Agency · Grand Terrace, CA · NPI 1083365910

NPD
The Heart Matters Foster Family Agency Foster Care Agency · Grand Terrace, CA · NPI 1265086094

NPD

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
The Heart Matters Foster Family Agency		Current since Jun 11, 2023	Accepting new patients
The Heart Matters Foster Family Agency		Current since Jun 11, 2023	Accepting new patients

Locations

21935 Van Buren St
Ste A1
Grand Terrace, CA 92313
Phone (909) 906-1023

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Counselor	101Y00000X
Rehabilitation Practitioner	225400000X			Yes

Addresses

Primary practice location

21935 Van Buren St Ste A1
Grand Terrace, CA 92313-5652

Mailing address

21935 Van Buren St Ste A1
Grand Terrace, CA 92313-5652
Phone (909) 906-1023

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 28, 2023.

{
    "created_epoch": "1686096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1558055913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21935 VAN BUREN ST STE A1",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135652",
            "telephone_number": "909-906-1023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21935 VAN BUREN ST STE A1",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135652",
            "telephone_number": "909-906-1023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANTT",
        "first_name": "DANNY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-07",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Terrace, CA

All providers in Grand Terrace, CA · Rehabilitation Practitioner in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.