Provider Demographics
NPI:1093329864
Name:GERVITA HOME CARE
Entity Type:Organization
Organization Name:GERVITA HOME CARE
Other - Org Name:GERVITA HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCK ROMUAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMBOU SILE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING STUDENT
Authorized Official - Phone:984-261-5621
Mailing Address - Street 1:101 S ELM ST STE 23
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2898
Mailing Address - Country:US
Mailing Address - Phone:984-261-5621
Mailing Address - Fax:
Practice Address - Street 1:3868 WEST AVE APT E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-4569
Practice Address - Country:US
Practice Address - Phone:984-369-4476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health