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General NPI Number Information
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NPI Number | 1538538608
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Entity Type | Organization
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Legal Business Name | GENTLE CARE NURSING SERVICE, INC
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 2479 78TH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19150-1824
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Country | US
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Telephone | 215-927-0958
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Fax |
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Provider Business Mailing Address
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Address Line | 2479 78TH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19150-1824
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Country | US
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Telephone | 215-927-0958
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SPADRINE MAVIS CLARKE
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Credential |
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Telephone | 215-927-0958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 10573601
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License Number State | PA
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