Provider Demographics
NPI:1336545490
Name:GENTLE HEART HOMECARE
Entity Type:Organization
Organization Name:GENTLE HEART HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GBADAMOSI
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:763-533-5500
Mailing Address - Street 1:5914 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2628
Mailing Address - Country:US
Mailing Address - Phone:763-913-0325
Mailing Address - Fax:
Practice Address - Street 1:7252 72ND LN N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1631
Practice Address - Country:US
Practice Address - Phone:763-913-0325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24827251E00000X
MN24847251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24827OtherMINNESOTA DEPARTMENT OF HEALTH