Healthcare Provider Details

I. General information

NPI: 1720755408
Provider Name (Legal Business Name): GENTLE LOVE AND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 US HIGHWAY 41 NW STE 11
JASPER FL
32052-5889
US

IV. Provider business mailing address

PO BOX 1782
JASPER FL
32052-1782
US

V. Phone/Fax

Practice location:
  • Phone: 386-292-6563
  • Fax: 866-462-5823
Mailing address:
  • Phone: 386-292-6563
  • Fax: 866-462-5823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LATIA LUMPKIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 386-292-6563