Provider Demographics
NPI:1043548811
Name:GENTLE SHEPHERD HEALTH CARE INC.
Entity Type:Organization
Organization Name:GENTLE SHEPHERD HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:RUIZ
Authorized Official - Last Name:POYAOAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:219-397-1779
Mailing Address - Street 1:3729 FIR ST
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-2227
Mailing Address - Country:US
Mailing Address - Phone:219-397-1779
Mailing Address - Fax:219-397-1977
Practice Address - Street 1:3729 FIR ST
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-2227
Practice Address - Country:US
Practice Address - Phone:219-397-1779
Practice Address - Fax:219-397-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-05
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN012248251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health