Healthcare Provider Details

I. General information

NPI: 1508584228
Provider Name (Legal Business Name): SALLYS GENTLE HANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 W SYLVANIA AVE
TOLEDO OH
43612-1702
US

IV. Provider business mailing address

1028 W SYLVANIA AVE
TOLEDO OH
43612-1702
US

V. Phone/Fax

Practice location:
  • Phone: 567-288-3015
  • Fax: 419-535-6657
Mailing address:
  • Phone: 567-288-3015
  • Fax: 419-535-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE SHAKERA GIST
Title or Position: OWNER
Credential: STNA
Phone: 567-288-3015