Provider Demographics
NPI:1326685801
Name:GENTLE CARE SUPPORTIVE SERVICES LLC
Entity Type:Organization
Organization Name:GENTLE CARE SUPPORTIVE SERVICES LLC
Other - Org Name:GENTLE CARE SUPPORTIVE SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALISHO
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:TRANSPORTATION
Authorized Official - Phone:423-541-5450
Mailing Address - Street 1:4040 ALEXIS CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37406-1281
Mailing Address - Country:US
Mailing Address - Phone:423-541-5450
Mailing Address - Fax:423-541-5451
Practice Address - Street 1:4040 ALEXIS CIR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-1281
Practice Address - Country:US
Practice Address - Phone:423-541-5450
Practice Address - Fax:423-541-5451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALISHO BATTLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-04
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ048141Medicaid