Healthcare Provider Details

I. General information

NPI: 1639235872
Provider Name (Legal Business Name): GENTLE HEARTS HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6047 TYVOLA GLEN CIR # 101
CHARLOTTE NC
28217-6431
US

IV. Provider business mailing address

6047 TYVOLA GLEN CIR # 101
CHARLOTTE NC
28217-6431
US

V. Phone/Fax

Practice location:
  • Phone: 704-414-6598
  • Fax: 704-599-9089
Mailing address:
  • Phone: 704-414-6598
  • Fax: 704-599-9089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE BRATHWAITE
Title or Position: AGENCY SUPERVISOR
Credential:
Phone: 704-414-6598