MEDICARE: GENTLE DIVINE TOUCH HOME CARE & CONCIERGE SERVICES

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	253Z00000X	In Home Supportive Care Agency	015788	TX
2	251E00000X	Home Health Agency	015788	TX

General Provider Information

NPI Number	:	1699106393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE DIVINE TOUCH HOME CARE & CONCIERGE SERVICES

Provider Business Mailing Address
First Line	:	4220 SPID DR
Second Line	:	SUITE 114
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-4479
Country	:	US
Telephone Number	:	361-225-2884
Fax Number	:	361-225-2885

Provider Business Practice Location Address
First Line	:	4220 SPID DR
Second Line	:	SUITE 114
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-4479
Country	:	US
Telephone Number	:	361-225-2884
Fax Number	:	361-225-2885

Authorized Official
Title or Position	:	OWNER
Name	:	RODNEY O WILLIAMS
Credential	:
Telephone Number	:	361-225-2884

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	04/21/2014

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