MEDICARE: MCL GENTLE CARE HOME HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1134953144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCL GENTLE CARE HOME HEALTH

Provider Business Mailing Address
First Line	:	7111 GARDEN GROVE BLVD STE 114
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92841-4295
Country	:	US
Telephone Number	:	714-863-2628
Fax Number	:

Provider Business Practice Location Address
First Line	:	7111 GARDEN GROVE BLVD STE 114
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92841-4295
Country	:	US
Telephone Number	:	714-863-2628
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MAYLENE LIM
Credential	:
Telephone Number	:	714-863-2628

Provider Enumeration Date	:	08/30/2024
Last Update Date	:	08/30/2024

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