Provider Demographics
NPI: | 1245400241 |
---|---|
Name: | GENTLE SPIRIT HOME CARE |
Entity Type: | Organization |
Organization Name: | GENTLE SPIRIT HOME CARE |
Other - Org Name: | IN HOME CARE AGENCY |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | CAROLINE |
Authorized Official - Middle Name: | ANN |
Authorized Official - Last Name: | BENEDICT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 760-992-8166 |
Mailing Address - Street 1: | 69295 MCCALLUM WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | CATHEDRAL CITY |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92234-2990 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 760-992-8166 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 69295 MCCALLUM WAY |
Practice Address - Street 2: | |
Practice Address - City: | CATHEDRAL CITY |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92234-2990 |
Practice Address - Country: | US |
Practice Address - Phone: | 760-992-8166 |
Practice Address - Fax: | 760-992-8166 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-03-05 |
Last Update Date: | 2008-03-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 009827 | 305S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 305S00000X | Managed Care Organizations | Point of Service |