Provider Demographics
NPI:1447888912
Name:GORDRELL ENTERPRISES LLC
Entity type:Organization
Organization Name:GORDRELL ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOMIKA
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-379-8787
Mailing Address - Street 1:2246 S HAMILTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4317
Mailing Address - Country:US
Mailing Address - Phone:614-946-5504
Mailing Address - Fax:
Practice Address - Street 1:2246 S HAMILTON RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4317
Practice Address - Country:US
Practice Address - Phone:614-946-5504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children