MEDICARE: GENTLE GUARDIAN SUPPORT SERVICES LLC

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1083402903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE GUARDIAN SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	3919 N CLEVELAND AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64117-2235
Country	:	US
Telephone Number	:	816-617-5167
Fax Number	:

Provider Business Practice Location Address
First Line	:	3919 N CLEVELAND AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64117-2235
Country	:	US
Telephone Number	:	816-617-5167
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	NIMO ABDIKARIM SAHIL
Credential	:
Telephone Number	:	816-617-5167

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	04/29/2025

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