Provider Demographics
NPI:1477903854
Name:GENTLE TOUCH ASSISTED LIVING FACILITY LLC.
Entity Type:Organization
Organization Name:GENTLE TOUCH ASSISTED LIVING FACILITY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-292-3596
Mailing Address - Street 1:4387 NW 42ND TER
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3859
Mailing Address - Country:US
Mailing Address - Phone:954-292-3596
Mailing Address - Fax:
Practice Address - Street 1:4387 NW 42ND TER
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-3859
Practice Address - Country:US
Practice Address - Phone:954-292-3596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENTLE TOUCH ASSISTED LIVING FACILITY LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12624251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12624Medicaid