=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881049740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENTLE TOUCH HEALTH INITIATIVES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2016
-----------------------------------------------------
Last Update Date | 04/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7115 WAYZATA BLVD
-----------------------------------------------------
City | ST LOUIS PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55426-1615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-641-0100
-----------------------------------------------------
Fax | 651-305-7170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7115 WAYZATA BLVD
-----------------------------------------------------
City | ST LOUIS PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55426-1615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-641-0100
-----------------------------------------------------
Fax | 651-305-7170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. MICHAEL B PAGH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 763-377-1800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 375259
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------