Healthcare Provider Details

I. General information

NPI: 1598140758
Provider Name (Legal Business Name): GENTLE HANDS HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 PLYMOUTH AVE STE 127
SAINT LOUIS MO
63133-1940
US

IV. Provider business mailing address

6439 PLYMOUTH AVE STE 127
SAINT LOUIS MO
63133-1940
US

V. Phone/Fax

Practice location:
  • Phone: 636-465-3004
  • Fax: 314-833-3170
Mailing address:
  • Phone: 636-465-3004
  • Fax: 314-833-3170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAUNICE NICOLE SHELTON
Title or Position: OWNER
Credential: BSN, RN
Phone: 636-465-3004