Provider Demographics
NPI:1295593416
Name:GENTLE LOVE
Entity type:Organization
Organization Name:GENTLE LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-931-4493
Mailing Address - Street 1:717 DOUGHERTY PL
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4647
Mailing Address - Country:US
Mailing Address - Phone:810-399-9428
Mailing Address - Fax:
Practice Address - Street 1:717 DOUGHERTY PL
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4647
Practice Address - Country:US
Practice Address - Phone:810-931-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services