Provider Demographics
NPI:1790490902
Name:GENTLE TOUCH PERSONAL CARE LLC
Entity Type:Organization
Organization Name:GENTLE TOUCH PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL CARE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-972-9699
Mailing Address - Street 1:625 BRITTON WAY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-4156
Mailing Address - Country:US
Mailing Address - Phone:478-320-6013
Mailing Address - Fax:
Practice Address - Street 1:625 BRITTON WAY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-4156
Practice Address - Country:US
Practice Address - Phone:478-320-6013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1851065361OtherSELF PAY