Provider Demographics
NPI:1487077640
Name:GARDNER, SANDRA (EXECUTIVE DIRECTOR)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:EXECUTIVE DIRECTOR
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:PHILLIPS
Other - Last Name:ESTELLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NA
Mailing Address - Street 1:555 RIDGEFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-5461
Mailing Address - Country:US
Mailing Address - Phone:205-234-9240
Mailing Address - Fax:
Practice Address - Street 1:555 RIDGEFIELD WAY
Practice Address - Street 2:
Practice Address - City:ODENVILLE
Practice Address - State:AL
Practice Address - Zip Code:35120-5461
Practice Address - Country:US
Practice Address - Phone:205-234-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide