MEDICARE: GENTLE SHEPHERD HOME HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	7763	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033177514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE SHEPHERD HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	2216 SHADOWLAKE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7440
Country	:	US
Telephone Number	:	405-691-8600
Fax Number	:	405-691-8601

Provider Business Practice Location Address
First Line	:	2216 SHADOWLAKE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7440
Country	:	US
Telephone Number	:	405-691-8600
Fax Number	:	405-691-8601

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW ELERICK
Credential	:
Telephone Number	:	405-691-8600

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/07/2025

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