Provider Demographics
NPI:1750036257
Name:SENIOR GENTLE CARE SERVICES LLC
Entity Type:Organization
Organization Name:SENIOR GENTLE CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESS
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-288-3989
Mailing Address - Street 1:348 WILLOWBAY RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6740
Mailing Address - Country:US
Mailing Address - Phone:407-288-3989
Mailing Address - Fax:
Practice Address - Street 1:407 W HUBBARD AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-6810
Practice Address - Country:US
Practice Address - Phone:407-288-3989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health