Healthcare Provider Details

I. General information

NPI: 1689547754
Provider Name (Legal Business Name): GENTLE HAVEN HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E WASHINGTON ST
PULASKI TN
38478-3415
US

IV. Provider business mailing address

502 E WASHINGTON ST
PULASKI TN
38478-3415
US

V. Phone/Fax

Practice location:
  • Phone: 256-750-2888
  • Fax:
Mailing address:
  • Phone: 256-750-2888
  • Fax: 256-686-3740

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: LATASHA MCCLENDON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 256-750-2888