Healthcare Provider Details

I. General information

NPI: 1821895319
Provider Name (Legal Business Name): GENTLE HOME CARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 E 71ST ST
CHICAGO IL
60619-1030
US

IV. Provider business mailing address

1510 E 55TH ST UNIT 15234
CHICAGO IL
60615-2591
US

V. Phone/Fax

Practice location:
  • Phone: 312-975-2933
  • Fax:
Mailing address:
  • Phone: 312-975-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ANGELIQUE TULLOCH
Title or Position: GENERAL MANAGER
Credential:
Phone: 312-975-2933