Provider Demographics
NPI:1912106311
Name:GENTLE LOVE VISITING PHYSICIANS GROUP LLC
Entity Type:Organization
Organization Name:GENTLE LOVE VISITING PHYSICIANS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-962-5580
Mailing Address - Street 1:2051 ROSA PARKS BLVD
Mailing Address - Street 2:STE 1 B
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1556
Mailing Address - Country:US
Mailing Address - Phone:313-962-5580
Mailing Address - Fax:313-962-5588
Practice Address - Street 1:2051 ROSA PARKS BLVD
Practice Address - Street 2:STE 1 B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1556
Practice Address - Country:US
Practice Address - Phone:313-962-5580
Practice Address - Fax:313-962-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty