Healthcare Provider Details

I. General information

NPI: 1760193098
Provider Name (Legal Business Name): GENTLE HAND GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 HEMPSTEAD DR
SOMERSET NJ
08873-3916
US

IV. Provider business mailing address

25 WINDING CREEK RD
STAFFORD VA
22554-3912
US

V. Phone/Fax

Practice location:
  • Phone: 609-212-8033
  • Fax:
Mailing address:
  • Phone: 540-919-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SAFFIATU JANNEH
Title or Position: CEO
Credential:
Phone: 540-919-2718