Provider Demographics
NPI:1679298111
Name:GALLAGHER, LORETTA (PRESIDENT)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S OLIVE AVE APT 2110
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6532
Mailing Address - Country:US
Mailing Address - Phone:954-868-5105
Mailing Address - Fax:
Practice Address - Street 1:25803 SW HANNAHS PATH
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-2120
Practice Address - Country:US
Practice Address - Phone:954-868-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker