Healthcare Provider Details

I. General information

NPI: 1700440369
Provider Name (Legal Business Name): GENTLE HANDS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 OAK MEADOW DR
CLINTON MS
39056-6044
US

IV. Provider business mailing address

135 OAK MEADOW DR
CLINTON MS
39056-6044
US

V. Phone/Fax

Practice location:
  • Phone: 601-454-9757
  • Fax:
Mailing address:
  • Phone: 601-454-9757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ROSE HOWARD
Title or Position: MEMBER
Credential: NURSING
Phone: 601-454-9757