Individual
SHANON T GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2364 CARVER AVE, KINGMAN, AZ 86409
(928) 757-3989
(928) 692-0398
Mailing address
1 E LEXINGTON AVE UNIT 1507, PHOENIX, AZ 85012-4202
(480) 438-1399
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12844C
AZ
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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