Provider Demographics
NPI:1841583846
Name:GENTLE HANDS HOME HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:GENTLE HANDS HOME HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:ELLIS EL
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MS
Authorized Official - Phone:757-241-0341
Mailing Address - Street 1:4410 CLAIBORNE SQ E
Mailing Address - Street 2:334
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2071
Mailing Address - Country:US
Mailing Address - Phone:757-241-0341
Mailing Address - Fax:866-667-2490
Practice Address - Street 1:4410 CLAIBORNE SQ E
Practice Address - Street 2:334
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2071
Practice Address - Country:US
Practice Address - Phone:757-241-0341
Practice Address - Fax:866-667-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053598532Medicaid