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General NPI Number Information
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NPI Number | 1477392181
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Entity Type | Organization
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Legal Business Name | A GENTLE CARE ALF RESIDENCE LLC
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 66 BLARE CASTLE DR
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City | PALM COAST
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State | FL
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Zip | 32137-7309
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Country | US
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Telephone | 860-867-8319
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Fax |
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Provider Business Mailing Address
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Address Line | 66 BLARE CASTLE DR
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City | PALM COAST
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State | FL
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Zip | 32137-7309
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KERRINE MCCALLUM
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Credential | RN
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Telephone | 860-867-8319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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