Provider Demographics
NPI:1598045627
Name:GENTLE TOUCH PROVIDER LLC
Entity Type:Organization
Organization Name:GENTLE TOUCH PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LETHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-748-7667
Mailing Address - Street 1:1101 W OAK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-2751
Mailing Address - Country:US
Mailing Address - Phone:985-748-7667
Mailing Address - Fax:
Practice Address - Street 1:1101 W OAK ST
Practice Address - Street 2:SUITE B
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2751
Practice Address - Country:US
Practice Address - Phone:985-748-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-20
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care