Provider Demographics
NPI:1033981527
Name:GENTLECARE LLC
Entity Type:Organization
Organization Name:GENTLECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORY
Authorized Official - Middle Name:O
Authorized Official - Last Name:OSADIAYE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, PMHNP-BC
Authorized Official - Phone:678-670-9554
Mailing Address - Street 1:780 MARTIN FIELD DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-5270
Mailing Address - Country:US
Mailing Address - Phone:678-670-9554
Mailing Address - Fax:
Practice Address - Street 1:250 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8432
Practice Address - Country:US
Practice Address - Phone:678-670-9554
Practice Address - Fax:678-539-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health