Provider Demographics
NPI:1053925313
Name:GORLEY, JEFFREY
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GORLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 NW 55TH BLVD APT 307
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3793
Mailing Address - Country:US
Mailing Address - Phone:305-469-6711
Mailing Address - Fax:
Practice Address - Street 1:304 SW 85TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-5417
Practice Address - Country:US
Practice Address - Phone:305-469-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No374U00000XNursing Service Related ProvidersHome Health Aide
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No372600000XNursing Service Related ProvidersAdult Companion