MEDICARE: GENTLE CARE SUPPORT SERVICES

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	172V00000X	Community Health Worker
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1538038997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE CARE SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	7428 HARTEL ST
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-5556
Country	:	US
Telephone Number	:	313-516-0830
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 GRAY ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48215-2043
Country	:	US
Telephone Number	:	313-516-0830
Fax Number	:	313-499-8423

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WILLIE HURST JR.
Credential	:
Telephone Number	:	734-363-7073

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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Directions to “GENTLE CARE SUPPORT SERVICES ” Practice Location

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