Healthcare Provider Details

I. General information

NPI: 1417511320
Provider Name (Legal Business Name): GENTLE MEDICARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18250 MARSH LN APT 515
DALLAS TX
75287-5707
US

IV. Provider business mailing address

18250 MARSH LN APT 515
DALLAS TX
75287-5707
US

V. Phone/Fax

Practice location:
  • Phone: 972-201-7204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: OLUMUYIWA MICHAEL
Title or Position: CEO
Credential:
Phone: 972-201-7204