Healthcare Provider Details

I. General information

NPI: 1588894091
Provider Name (Legal Business Name): GENTLE HANDS HOME SERVICES LL.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 HYANNIS PORT DR
INDIANAPOLIS IN
46214-1214
US

IV. Provider business mailing address

3504 HYANNIS PORT DR
INDIANAPOLIS IN
46214-1214
US

V. Phone/Fax

Practice location:
  • Phone: 317-506-4136
  • Fax: 317-299-9166
Mailing address:
  • Phone: 317-506-4136
  • Fax: 317-299-9166

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. JASON ANTONIO DAVIS
Title or Position: OWNER
Credential:
Phone: 317-506-4136