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General NPI Number Information
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NPI Number | 1124328737
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Entity Type | Organization
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Legal Business Name | GENTLE CARE LIVING CENTER
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 12660 MEDFIELD DR STE.418
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City | HOUSTON
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State | TX
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Zip | 77082-5432
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Country | US
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Telephone | 832-775-5203
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Fax | 832-775-5204
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Provider Business Mailing Address
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Address Line | 2801 WALNUT BEND LN STE.68
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City | HOUSTON
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State | TX
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Zip | 77042-3464
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Country | US
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Telephone | 832-775-5203
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Fax | 832-775-5204
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. VANAVIA NAOMI RICHARDSON
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Credential | N/A
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Telephone | 832-775-5203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 3748
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License Number State | TX
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