Provider Demographics
NPI:1063445583
Name:GENTLE CARE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:GENTLE CARE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YADELKIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-822-9188
Mailing Address - Street 1:7330 WEST 20 AVENUE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4590
Mailing Address - Country:US
Mailing Address - Phone:305-822-9188
Mailing Address - Fax:305-822-9188
Practice Address - Street 1:7330 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1835
Practice Address - Country:US
Practice Address - Phone:305-822-9188
Practice Address - Fax:305-822-9132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991948251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651209700Medicaid
FL651209700Medicaid