Provider Demographics
NPI:1407157746
Name:GENTLE CARE ASSISTED LIVING HOME 2
Entity Type:Organization
Organization Name:GENTLE CARE ASSISTED LIVING HOME 2
Other - Org Name:GENTLE CARE ASSISTED LIVING HOME 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LICENSEE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:RONDILLA
Authorized Official - Last Name:NATIVIDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-295-9214
Mailing Address - Street 1:1302 S TUMBLEWEED CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7643
Mailing Address - Country:US
Mailing Address - Phone:602-295-9214
Mailing Address - Fax:482-219-1607
Practice Address - Street 1:1302 S TUMBLEWEED CT
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-7643
Practice Address - Country:US
Practice Address - Phone:602-295-9214
Practice Address - Fax:482-219-1607
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIA R. NATIVIDAD,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8042H172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty