Provider Demographics
NPI:1114279676
Name:GENTLE CARE PERSONAL SERVICES LLC
Entity Type:Organization
Organization Name:GENTLE CARE PERSONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:WONYIAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEKARKEH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-476-4639
Mailing Address - Street 1:650 DALE SCHRIER DR
Mailing Address - Street 2:SUITE 6505
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2501
Mailing Address - Country:US
Mailing Address - Phone:317-476-4639
Mailing Address - Fax:
Practice Address - Street 1:650 DALE SCHRIER DR
Practice Address - Street 2:SUITE 6505
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2501
Practice Address - Country:US
Practice Address - Phone:317-476-4639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12-012895-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care