1053598532 NPI number — GENTLE HANDS HOME HEATHCARE SERVICES, LLC

Table of content: (NPI 1053598532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053598532 NPI number — GENTLE HANDS HOME HEATHCARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENTLE HANDS HOME HEATHCARE SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GENTLE HAND HOME HEALTHCARE,INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053598532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 KEMPSVILLE RD STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23464-2723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-495-1451
Provider Business Mailing Address Fax Number:
757-495-1453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 KEMPSVILLE RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23464-2723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-495-1451
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS EL
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
KAYE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
757-495-1451

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  PORTSMOUTH23 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251G00000X , with the licence number: PORTSMOUTH23 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: PORTSMOUTH , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PORTSMOUTH23 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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