Healthcare Provider Details
I. General information
NPI: 1811166911
Provider Name (Legal Business Name): GENTLE TOUCH PERSONAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
405 FOXCROFT DR
SLIDELL LA
70461-3420
US
IV. Provider business mailing address
405 FOXCROFT DR
SLIDELL LA
70461-3420
US
V. Phone/Fax
- Phone: 985-288-7642
- Fax:
- Phone: 985-288-7642
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 302F00000X |
| Taxonomy | Exclusive Provider Organization |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 305R00000X |
| Taxonomy | Preferred Provider Organization |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MRS.
TEMECHIUS
LA'TRECE
REYNOLDS
Title or Position: OWNER
Credential:
Phone: 985-288-7642