MEDICARE: GENTLE HANDS HOME SERVICES LL.C.

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	253Z00000X	In Home Supportive Care Agency		IN
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1588894091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE HANDS HOME SERVICES LL.C.

Provider Business Mailing Address
First Line	:	3504 HYANNIS PORT DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-1214
Country	:	US
Telephone Number	:	317-506-4136
Fax Number	:	317-299-9166

Provider Business Practice Location Address
First Line	:	3504 HYANNIS PORT DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-1214
Country	:	US
Telephone Number	:	317-506-4136
Fax Number	:	317-299-9166

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JASON ANTONIO DAVIS
Credential	:
Telephone Number	:	317-506-4136

Provider Enumeration Date	:	07/17/2009
Last Update Date	:	07/17/2009

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