Healthcare Provider Details

I. General information

NPI: 1093347205
Provider Name (Legal Business Name): GENTLE SHEPHERD CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 J N PEASE PL
CHARLOTTE NC
28262-4504
US

IV. Provider business mailing address

8604 CLIFF CAMERON DR STE 144
CHARLOTTE NC
28269-8512
US

V. Phone/Fax

Practice location:
  • Phone: 704-209-5040
  • Fax:
Mailing address:
  • Phone: 704-209-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: EMMA SOY
Title or Position: DIRECTOR
Credential: RN
Phone: 847-340-6546