Provider Demographics
NPI:1710400684
Name:GENTLE HEARTS HOME CARE AGENCY, LLC
Entity Type:Organization
Organization Name:GENTLE HEARTS HOME CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:610-626-1893
Mailing Address - Street 1:703 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PRIMOS
Mailing Address - State:PA
Mailing Address - Zip Code:19018-2116
Mailing Address - Country:US
Mailing Address - Phone:610-626-1893
Mailing Address - Fax:610-622-2918
Practice Address - Street 1:703 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PRIMOS
Practice Address - State:PA
Practice Address - Zip Code:19018-2116
Practice Address - Country:US
Practice Address - Phone:610-626-1893
Practice Address - Fax:610-622-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103078500-001253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103078500-0001Medicaid