Healthcare Provider Details

I. General information

NPI: 1821918889
Provider Name (Legal Business Name): GENTLEGLEAM HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 EXECUTIVE CENTER DR STE 234
CHARLOTTE NC
28212-8821
US

IV. Provider business mailing address

5500 EXECUTIVE CENTER DR STE 234
CHARLOTTE NC
28212-8821
US

V. Phone/Fax

Practice location:
  • Phone: 704-458-4934
  • Fax:
Mailing address:
  • Phone: 704-458-4934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ISAAC ENWEANA
Title or Position: ADMINISTRATION MANAGER
Credential:
Phone: 704-458-4934