Healthcare Provider Details

I. General information

NPI: 1235068214
Provider Name (Legal Business Name): GENTLE GRACE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 HALSTEAD BLVD STE 26D
ELIZABETH CITY NC
27909-6816
US

IV. Provider business mailing address

100 FANNIE DR
ELIZABETH CITY NC
27909-7009
US

V. Phone/Fax

Practice location:
  • Phone: 252-333-2514
  • Fax:
Mailing address:
  • Phone: 252-333-2514
  • 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: MR. CORIAN OBRIEN SHAW SR.
Title or Position: OWNER
Credential:
Phone: 252-333-2514