Provider Demographics
NPI:1497583389
Name:GONDECK SERVICES LLC
Entity type:Organization
Organization Name:GONDECK SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:GONDECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-600-4622
Mailing Address - Street 1:2006 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153-9600
Mailing Address - Country:US
Mailing Address - Phone:920-600-4622
Mailing Address - Fax:
Practice Address - Street 1:2006 PARK AVE
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153-9600
Practice Address - Country:US
Practice Address - Phone:920-600-4622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty