Healthcare Provider Details

I. General information

NPI: 1396236048
Provider Name (Legal Business Name): GENTLE LOVE AND CARE ASSISTED LIVING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 3RD ST NW
JASPER FL
32052-8915
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 Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

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