Healthcare Provider Details

I. General information

NPI: 1447889274
Provider Name (Legal Business Name): GO GENTLY MEDICAL GROUP. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 PROFESSIONAL DR STE 210
ROSEVILLE CA
95661-3776
US

IV. Provider business mailing address

206 N 2100 W STE 202
SALT LAKE CITY UT
84116-4741
US

V. Phone/Fax

Practice location:
  • Phone: 916-970-1700
  • Fax: 916-751-7290
Mailing address:
  • Phone: 801-325-0175
  • Fax: 801-478-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA BROADWAY
Title or Position: CHIEF QUALITY OFFICER
Credential:
Phone: 254-760-5743