Provider Demographics
NPI:1720307747
Name:GENTLE SHEPHERD HOSPICE, INC
Entity Type:Organization
Organization Name:GENTLE SHEPHERD HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKENROTH
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:540-989-6265
Mailing Address - Street 1:6045 PETERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4029
Mailing Address - Country:US
Mailing Address - Phone:540-989-6265
Mailing Address - Fax:540-989-1547
Practice Address - Street 1:154 HANSEN RD
Practice Address - Street 2:SUITE 202-C
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8839
Practice Address - Country:US
Practice Address - Phone:434-220-6002
Practice Address - Fax:434-202-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHSP-10172251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4910133Medicaid
VA4910133Medicaid