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General NPI Number Information
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NPI Number | 1538038997
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Entity Type | Organization
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Legal Business Name | GENTLE CARE SUPPORT SERVICES
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 4800 GRAY ST
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City | DETROIT
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State | MI
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Zip | 48215-2043
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Country | US
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Telephone | 313-516-0830
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Fax | 313-499-8423
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Provider Business Mailing Address
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Address Line | 7428 HARTEL ST
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City | WESTLAND
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State | MI
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Zip | 48185-5556
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Country | US
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Telephone | 313-516-0830
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIE HURST JR.
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Credential |
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Telephone | 734-363-7073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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