Provider Demographics
NPI:1205658226
Name:GENTLE HEARTS PERSONAL CARE AGENCY LLC
Entity type:Organization
Organization Name:GENTLE HEARTS PERSONAL CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUDEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEYIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-932-4363
Mailing Address - Street 1:2580 MORSE DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8826
Mailing Address - Country:US
Mailing Address - Phone:501-733-7700
Mailing Address - Fax:
Practice Address - Street 1:4555 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3670
Practice Address - Country:US
Practice Address - Phone:501-733-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty