Jennipher Lynn Gibbons
Custodial Care Facility in Edmore, MI. Individual provider (NPI-1).
NPI number1609595024
StatusActive
Last updated in NPPESAug 29, 2022
Details
- NPI
- 1609595024
- Entity type
- Individual (NPI-1)
- Name
- Jennipher Lynn Gibbons
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 29, 2022
- Certification date
- Aug 12, 2022
- Last updated
- Aug 29, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 311Z00000X | Custodial Care Facility | AF590409770 | MI | Yes |
Practice location
1850 W Michigan AveEdmore, MI 48829-9376
Phone 989-560-1301
Mailing address
1850 W Michigan AveEdmore, MI 48829-9376
Phone 989-560-1301
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