Healthcare Provider Details

I. General information

NPI: 1417603051
Provider Name (Legal Business Name): HOME OF GENTLE CARE, CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 BAREFIELD LN
CONSHOHOCKEN PA
19428-3226
US

IV. Provider business mailing address

224 BAREFIELD LN
CONSHOHOCKEN PA
19428-3226
US

V. Phone/Fax

Practice location:
  • Phone: 484-213-0378
  • Fax:
Mailing address:
  • Phone: 484-213-0378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RASIDAH CAMPBELL
Title or Position: CEO
Credential: PHARMD
Phone: 484-213-0378