Provider Demographics
NPI:1194957290
Name:GAIA ENTERPRISES INC
Entity type:Organization
Organization Name:GAIA ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TIBBETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-799-2237
Mailing Address - Street 1:50 MARKET ST STE 1A #151
Mailing Address - Street 2:
Mailing Address - City:S PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3666
Mailing Address - Country:US
Mailing Address - Phone:207-799-2237
Mailing Address - Fax:207-799-0217
Practice Address - Street 1:286 FRONT ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1558
Practice Address - Country:US
Practice Address - Phone:207-799-2237
Practice Address - Fax:207-799-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-23
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME154040000Medicaid