Healthcare Provider Details

I. General information

NPI: 1346775673
Provider Name (Legal Business Name): A GENTLE TOUCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 TREES EDGE LN
BLACK JACK MO
63033-4574
US

IV. Provider business mailing address

4780 TREES EDGE LN
BLACK JACK MO
63033-4574
US

V. Phone/Fax

Practice location:
  • Phone: 314-853-9312
  • Fax:
Mailing address:
  • Phone: 314-853-9312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MAURICE HENDRICKS
Title or Position: DIRECTOR
Credential:
Phone: 314-853-9312