Healthcare Provider Details

I. General information

NPI: 1598380339
Provider Name (Legal Business Name): GENTLE LOVE AND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7940 FRONT BEACH RD # 2003
PANAMA CITY BEACH FL
32407-4817
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 Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

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